Clopidogrel bisulfate (Plavix) does not increase bleeding complications in patients undergoing rubber band ligation for symptomatic hemorrhoids

J Surg Res. 2018 Sep;229:230-233. doi: 10.1016/j.jss.2018.04.004. Epub 2018 May 2.


Background: The incidence of postprocedural bleeding in patients undergoing rubber band ligation (RBL) for symptomatic internal hemorrhoids while taking clopidogrel bisulfate is unknown. To determine the postprocedural bleeding risk of RBL for patients taking clopidogrel compared with age- and sex-matched controls.

Materials and methods: This is a retrospective case-controlled cohort study analyzing data from 2005 to 2013 conducted at a single tertiary care academic center. The study included a total of 80 rubber bands placed on 41 patients taking clopidogrel bisulfate and 72 bands placed on 41 control patients not taking clopidogrel matched for age and sex. The 30-d rates of significant and insignificant bleeding events after RBL were recorded. A bleeding event was considered significant if the patient required admission to the hospital, transfusion of blood products, or additional procedures to stop the bleeding. Insignificant bleeding was defined as passage of blood or clots per rectum with spontaneous cessation and no need for additional intervention.

Results: There was no significant difference in the number of bleeding events per band placed in the clopidogrel group when compared with the control group (3.75% versus 2.78%, P = 0.7387). The rate of significant (2.5% versus 1.39%, P = 0.6244) and insignificant bleeding events (1.25% versus 1.39%, P = 0.9399) was also similar between the two groups. Two significant bleeding events occurred in the clopidogrel group requiring intervention: cauterization in one patient and colonoscopy and transfusion in the other.

Conclusions: The risk of a bleeding complication after RBL for hemorrhoids does not appear to be increased in patients taking clopidogrel. Our results support the practice of continuing clopidogrel bisulfate in the periprocedural period as the associated risk of thrombosis is greater than the risk of bleeding.

Keywords: Bleeding complication; Clopidogrel; Hemorrhoids; Rubber band ligation.

MeSH terms

  • Aged
  • Clopidogrel / adverse effects*
  • Female
  • Hemorrhoids / surgery*
  • Humans
  • Incidence
  • Ligation / adverse effects
  • Ligation / methods
  • Male
  • Perioperative Period
  • Platelet Aggregation Inhibitors / adverse effects*
  • Postoperative Hemorrhage / epidemiology*
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / surgery
  • Recurrence
  • Retrospective Studies
  • Thrombosis / etiology
  • Thrombosis / prevention & control*
  • Treatment Outcome


  • Platelet Aggregation Inhibitors
  • Clopidogrel