Polidocanol foam injection sclerotherapy in patients with mixed hemorrhoids with bleeding receiving antithrombotic drugs: a report of 7 cases

[Objectives] To share the clinical application experience of polidocanol foam injection sclerotherapy in patients with mixed hemorrhoids with bleeding who received antithrombotic drugs. [Methods] From March 2018 to May 2023, we retrospectively analyzed the clinical data of 7 patients with mixed hemorrhoids with bleeding who were treated by injection of polidocanol foam injection sclerotherapy in the Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine. All patients received antithrombotic drugs at the same time. Compare the operation time, intraoperative blood loss, preoperative thrombin time (TT), preoperative prothrombin time (PT), preoperative international normalized ratio (INR), preoperative hemoglobin (Hb) level, and the improvement of bleeding, prolapse, and other symptoms in the outpatient follow-up patients 4 weeks after the end of the injection, to detect the hemoglobin level, and evaluate the patients’ efficacy. [Results] Seven patients stopped bleeding successfully after injection of polidocanol foam sclerosing agent. The operation time ranged from 10 to 30 minutes. At the 4-week follow-up after surgery, all patients did not experience any further bleeding. Among the 7 patients, 3 had moderate to severe anemia, 2 had moderate anemia, and 2 had mild anemia before surgery, with hemoglobin levels ranging from 49 to 95 g/L. During the 4-week postoperative follow-up, there were 1 case of moderate anemia, 5 cases of mild anemia, and 1 case of normal Hb level, with hemoglobin levels ranging from 83 to 136 g/L. Four weeks after surgery, all patients reached the level of cure and were satisfied with the treatment. No serious complications occurred, and only one patient experienced hemorrhoids with bleeding again after one year of follow-up. The patient improved after undergoing hemorrhoids injection treatment. [Conclusion] Polidocanol foam injection sclerotherapy has a certain clinical effect on patients with mixed hemorrhoids with bleeding who receive antithrombotic drugs. However, larger multi-center prospective studies are needed before making it the preferred treatment for such patients.