Secondary haemorrhage after rubber band ligation of haemorrhoids in patients taking clopidogrel--a cautionary note.

Rubber band ligation (RBL) of symptomatic internal haemorrhoids, a technique refined by Barron' in the early 1960's, is a well-tolerated and effective procedure which can be performed in an outpatient setting. It is recommended as the initial mode of therapy for grades 1 to 3 haemorrhoids.2 However, the procedure is not without complications. Pain, secondary haemorrhage and life threatening pelvic sepsis are rare but have been described.3 Secondary haemorrhage occurs up to two weeks postprocedure when the bands slough off the haemorrhoidal mucosa, possibly in the presence of concurrent infection,3 leaving an ulcer with a blood vessel at its base. Patients are at greater risk of secondary haemorrhage if taking anti-platelet and/or anti-coagulant medication.3'4