Patients who have had heart valve replacements and vascular stent placements require long-term anticoagulant medications, so what should these patients do when they need surgical treatment for hemorrhoid fistula? This is a difficult problem for anorectal surgeons. In recent years, I have treated about 8 such patients, and with the cooperation of cardiologists and peripheral vascular surgeons, the patients have safely passed the perioperative period. In order to give colleagues a reference, I would like to share with you a recent case of a patient who stopped or changed anticoagulants in the perioperative period. The patient, a 61-year-old female, was admitted to the hospital on November 2, 2015 for “recurrent episodes of intra-anal mass prolapse for six months” and was diagnosed with mixed hemorrhoids and wanted to undergo external peeling and internal ligation of the mixed hemorrhoids. The patient had undergone a heart valve replacement in July 2013 and had been taking warfarin postoperatively. To prevent hemorrhoid bleeding during and after surgery, oral warfarin should normally be stopped and replaced by subcutaneous injection of low molecular weight heparin sodium for one week before surgery. In order to ensure safety, we communicated with the cardiologist, who advised: 1. stop warfarin, monitor PT.INR (International Normalized Ratio) <1.8< span=""> to operate; 2. low molecular weight heparin sodium injection (Qi Zheng) 6000 IU Q12h (once every 12 hours, i.e. once at 9 am and once at 9 pm); 3. choose the operation time in the morning, stop using low molecular weight heparin sodium in the morning of the operation day One injection of low molecular weight heparin sodium and another subcutaneous injection of low molecular weight heparin sodium 8 hours after surgery. According to the consultation recommendation of the cardiologist, oral warfarin was stopped in the afternoon of the day of admission and low molecular weight heparin sodium was given subcutaneously 6000 IU Q12h, and the coagulation quadruple PT.INR: 1.13<1.8< span=""> was checked on November 5, 2015, which met the surgical criteria of the consultation, and a mixed hemorrhoid external peel and internal ligation was performed under local anesthesia at 8:00 a.m. on November 6, 2015 The surgery went smoothly and continued with one subcutaneous injection of low-molecular-weight heparin sodium 8 hours after surgery, and thereafter daily low-molecular-weight heparin sodium injection (Qi Zheng) 6000 IU Q12h (once every 12 hours, i.e., once at 9:00 am and once at 9:00 pm); daily herbal sitz baths and drug changes were performed routinely. On the 9th postoperative day, the patient’s trauma still had 3 ligature threads that were not dislodged, and the root of the ligature threads could be clearly seen by pulling the anus (the patient’s gluteal groove was shallow), and there was no sign of major bleeding from the trauma, even if the bleeding was within the controllable range. After checking the coagulation four PT.INR: 0.89, after communicating with the cardiologist again, oral warfarin 3mg was administered at 4 pm on the same day, and low molecular weight heparin sodium 5000 IU Q12h was administered at the same time, after the two anticoagulants overlapped for 2 days (usually patients need to overlap for 3 days, but the patient reported that he was more sensitive to warfarin), low molecular heparin was stopped, and since November 17, 2015 Warfarin 3 mg orally at 4 pm daily (3 mg is the imported warfarin dose, the domestic dose is 2.5 mg). On November 18, 2015, the PT.INR: 0.89, prothrombin time: 12.2sec. (Generally, the INR is observed for about 3 days orally, at which time the patient is advised to recheck the four coagulation items after three days and adjust the warfarin dosage according to the INR value) The patient’s ligature line in the operation area was all dislodged at noon on the 18th, and he was successfully discharged on the 19th. The patient’s general condition was good at the follow-up examination two weeks after discharge. The trauma was healed and the anal function was normal.