title: Hemorrhoids screening and treatment prior to LVAD: is it a necessity?
abstract: Continuous-flow left ventricle assist devices (CF-LVADs) has become an essential modality in the management of stage D heart failure (HF) with significant improvement in survival and quality of life. Due to the durability of such devices and long term support complications such as bleeding and aortic insufficiency has emerged. Bleeding accounts for more than 20 % with the majority being from the gastrointestinal tract. The increase of bleeding tendency are mainly attributed to the loss of large von Willebrand's Factor (vWF) multimers due to shear stress with the chronic intake of anticoagulants. We are reporting two cases of patients with Stage D HF and history of hemorrhoids presenting for LVAD implantation. Many efforts that decrease bleeding related to CF-LVADs will be discussed with focus on hemorrhoids.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hadi
authors.initials: H
authors.lastname: Skouri
authors.affiliation: National Heart, Lung & Transplant Institute, An-Najah National University Hospital, An-Najah National University, Nablus, West Bank, Palestine.|Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, West Bank, Palestine.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shurrab
authors.affiliation: Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Jad
authors.initials: J
authors.lastname: Zahnan
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Samer
authors.initials: S
authors.lastname: Deeba
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Pierre
authors.initials: P
authors.lastname: Sfeir
authors.affiliation: Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Walid
authors.initials: W
authors.lastname: Gharzuddin
authors.affiliation: National Heart, Lung & Transplant Institute, An-Najah National University Hospital, An-Najah National University, Nablus, West Bank, Palestine. hajsaleem@gmail.com.|Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, West Bank, Palestine. hajsaleem@gmail.com.
authors.forename: Saleem
authors.initials: S
authors.lastname: Haj-Yahia
mesh_terms: D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006484:Hemorrhoids / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods
keywords: Hemorrhoids; LVAD; Screening