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항응고제 복용 중인 환자에서의 치핵절제술은 안전한가?

Is a Hemorrhoidectomy Safe in Patients Requiring Anticoagulation?

대한대장항문학회지 2003년 19권 6호 p.360 ~ 366
조재영 ( Cho Jai-Young ) - 서울대학교 의과대학 외과학교실

임석병 ( Lim Seok-Byung ) - 서울대학교 의과대학 외과학교실
이민로 ( Lee Min-Ro ) - 서울대학교 의과대학 외과학교실
박규주 ( Park Kyu-Joo ) - 서울대학교 의과대학 외과학교실


Purpose: The aim of this study was to determine the risks of a hemorrhoidectomy in patients requiring long-term anticoagulation.

Methods: Between March 1998 and February 2001, 13 patients requiring long-term oral anticoagulation because of prosthetic valve replacement (n=4), atrial fibrillation (n=7), and coronary artery disease (n=2) underwent a hemorrhoidectomy at Seoul National University Hospital. We performed a retrospective analysis on these patients regarding the results of the hemorrhoidectomy. The control group consisted of 148 patients without any medical problems who had undergone a hemorrhoidectomy during the same period. Patients on anticoagulation stopped their oral medication three days before the operation and full intravenous (IV) heparinization was commenced. Heparin was stopped six hours before the operation and restarted postoperatively, and warfarin was re-started on the evening of postoperative day 1. The hemorrhoidectomy consisted of excising three main piles, followed by submucosal excision of all intervening piles. Student´s t-test and Fisher´s exact test were used for statistical analysis.

Results: The PTs (prothrombin times) of the anticoagulation group and the control group obtained at admission were INRs (international normalized ratios) of 1.75±0.54 and 1.04±0.08, respectively (P=0.0005). After discontinuation of oral medication and full IV heparinization, the INR of the anticoagulation group at the time of operation was 1.06±0.09, which was not statistically different from the PT (INR) of the control group at admission (P=0.603). There were two cases of postoperative bleeding requiring blood transfusions in the anticoagulation group (15.4%), and four cases of postoperative bleeding requiring blood transfusions in the control group (2.7%), but there was no statistical difference between the rates for the two groups (P=0.075). The mean postoperative hospital stays were 6.69±3.68 and 3.64±2.98 for the anticoagulation and control groups, respectively (P=0.074). Postoperative analgesic requirements and urinary difficulty were similar in both groups (P=0.478 and 0.397, respectively). No systemic thromboembolism in both groups, and there was no bacterial endocarditis or valvular thrombosis was seen in patients with prosthetic heart valves.

Conclusions: Our results indicate that patients taking oral warfarin for anticoagulation may safely undergo a hemorrhoidectomy after strict heparinization. J Korean Soc Coloproctol 2003;19:360-366


치핵/수술;항응고제/치료적 사용;합병증
Hemorrhoids/surgery;Anticoagulants/therapeutic use;Complication
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