Anticoagulation management following left ventricular assist device implantation is similar across all provider strategies

Asia McDavid, Kelly MacBrair, Sitaramesh Emani, Lianbo Yu, Peter H.U. Lee, Bryan A. Whitson, Brent C. Lampert, Riddhima Agarwal, Ahmet Kilic

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Thromboembolic and bleeding events are potential complications following left ventricular assist device implantation. A tight control of the international normalized ratio (INR) is believed to be crucial in the reduction of postimplant complications. There is significant variability among institutions as to whether a device implanting centre should be managing the INR. In this study, we evaluated the effect of INR management strategies in maintaining a therapeutic INR. METHODS: A retrospective review was utilized to identify patients implanted with either the HeartMate II or the HeartWare HVAD between January 2011 and February 2016. Patients were stratified into 4 groups based on the post-discharge INR management strategy: outside hospital system anticoagulation clinic, outside hospital primary care provider, implanting centre anticoagulation clinic or implanting centre ventricular assist device office. The INR data were collected and analysed for both the early (discharge, 7, 14, 21 and 30 days) and late (3, 6, 9 and 12 months) postoperative periods. RESULTS: There were 163 patients identified during the study period who met the study inclusion criteria: 49 (30%) patients were managed by an outside hospital system anticoagulation clinic, 59 (36.2%) patients by an outside hospital physician/primary care provider, 22 (13.5%) patients by the implanting centre anticoagulation clinic and 33 (20.2%) patients by the implanting centre ventricular assist device office. There were no statistically significant differences found between management strategies across all time points. CONCLUSIONS: There was no statistically significant difference found between the management strategies examined. Regardless of the chosen INR management strategy, patients have similar INR values and postoperative outcomes.

Original languageEnglish (US)
Pages (from-to)60-65
Number of pages6
JournalInteractive Cardiovascular and Thoracic Surgery
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Heart-Assist Devices
International Normalized Ratio
Primary Care Physicians
Postoperative Period
Primary Health Care
Hemorrhage
Equipment and Supplies

Keywords

  • International normalized ratio
  • Mechanical circulatory support
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Anticoagulation management following left ventricular assist device implantation is similar across all provider strategies. / McDavid, Asia; MacBrair, Kelly; Emani, Sitaramesh; Yu, Lianbo; Lee, Peter H.U.; Whitson, Bryan A.; Lampert, Brent C.; Agarwal, Riddhima; Kilic, Ahmet.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 26, No. 1, 01.01.2018, p. 60-65.

Research output: Contribution to journalArticle

McDavid, Asia ; MacBrair, Kelly ; Emani, Sitaramesh ; Yu, Lianbo ; Lee, Peter H.U. ; Whitson, Bryan A. ; Lampert, Brent C. ; Agarwal, Riddhima ; Kilic, Ahmet. / Anticoagulation management following left ventricular assist device implantation is similar across all provider strategies. In: Interactive Cardiovascular and Thoracic Surgery. 2018 ; Vol. 26, No. 1. pp. 60-65.
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abstract = "OBJECTIVES: Thromboembolic and bleeding events are potential complications following left ventricular assist device implantation. A tight control of the international normalized ratio (INR) is believed to be crucial in the reduction of postimplant complications. There is significant variability among institutions as to whether a device implanting centre should be managing the INR. In this study, we evaluated the effect of INR management strategies in maintaining a therapeutic INR. METHODS: A retrospective review was utilized to identify patients implanted with either the HeartMate II or the HeartWare HVAD between January 2011 and February 2016. Patients were stratified into 4 groups based on the post-discharge INR management strategy: outside hospital system anticoagulation clinic, outside hospital primary care provider, implanting centre anticoagulation clinic or implanting centre ventricular assist device office. The INR data were collected and analysed for both the early (discharge, 7, 14, 21 and 30 days) and late (3, 6, 9 and 12 months) postoperative periods. RESULTS: There were 163 patients identified during the study period who met the study inclusion criteria: 49 (30{\%}) patients were managed by an outside hospital system anticoagulation clinic, 59 (36.2{\%}) patients by an outside hospital physician/primary care provider, 22 (13.5{\%}) patients by the implanting centre anticoagulation clinic and 33 (20.2{\%}) patients by the implanting centre ventricular assist device office. There were no statistically significant differences found between management strategies across all time points. CONCLUSIONS: There was no statistically significant difference found between the management strategies examined. Regardless of the chosen INR management strategy, patients have similar INR values and postoperative outcomes.",
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AU - MacBrair, Kelly

AU - Emani, Sitaramesh

AU - Yu, Lianbo

AU - Lee, Peter H.U.

AU - Whitson, Bryan A.

AU - Lampert, Brent C.

AU - Agarwal, Riddhima

AU - Kilic, Ahmet

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AB - OBJECTIVES: Thromboembolic and bleeding events are potential complications following left ventricular assist device implantation. A tight control of the international normalized ratio (INR) is believed to be crucial in the reduction of postimplant complications. There is significant variability among institutions as to whether a device implanting centre should be managing the INR. In this study, we evaluated the effect of INR management strategies in maintaining a therapeutic INR. METHODS: A retrospective review was utilized to identify patients implanted with either the HeartMate II or the HeartWare HVAD between January 2011 and February 2016. Patients were stratified into 4 groups based on the post-discharge INR management strategy: outside hospital system anticoagulation clinic, outside hospital primary care provider, implanting centre anticoagulation clinic or implanting centre ventricular assist device office. The INR data were collected and analysed for both the early (discharge, 7, 14, 21 and 30 days) and late (3, 6, 9 and 12 months) postoperative periods. RESULTS: There were 163 patients identified during the study period who met the study inclusion criteria: 49 (30%) patients were managed by an outside hospital system anticoagulation clinic, 59 (36.2%) patients by an outside hospital physician/primary care provider, 22 (13.5%) patients by the implanting centre anticoagulation clinic and 33 (20.2%) patients by the implanting centre ventricular assist device office. There were no statistically significant differences found between management strategies across all time points. CONCLUSIONS: There was no statistically significant difference found between the management strategies examined. Regardless of the chosen INR management strategy, patients have similar INR values and postoperative outcomes.

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