Asia McDavid1, Kelly MacBrair1, Sitaramesh Emani2, Lianbo Yu3, Peter H U Lee1, Bryan A Whitson1, Brent C Lampert2, Riddhima Agarwal1, Ahmet Kilic1. 1. Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 2. Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, Columbus, OH, USA.
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.
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.
Authors: Michael S Kiernan; Susan M Joseph; Jason N Katz; Ahmet Kilic; Jonathan D Rich; Mark P Tallman; Peter Van Buren; James J Lyons; Brian Bethea; Peter Eckman; Igor Gosev; Sangjin S Lee; Behzad Soleimani; Hiroo Takayama; Chetan B Patel; Nir Uriel Journal: Circ Heart Fail Date: 2015-05 Impact factor: 8.790
Authors: Randall C Starling; Nader Moazami; Scott C Silvestry; Gregory Ewald; Joseph G Rogers; Carmelo A Milano; J Eduardo Rame; Michael A Acker; Eugene H Blackstone; John Ehrlinger; Lucy Thuita; Maria M Mountis; Edward G Soltesz; Bruce W Lytle; Nicholas G Smedira Journal: N Engl J Med Date: 2013-11-27 Impact factor: 91.245
Authors: Andrew J Boyle; Stuart D Russell; Jeffrey J Teuteberg; Mark S Slaughter; Nader Moazami; Francis D Pagani; O Howard Frazier; Gerald Heatley; David J Farrar; Ranjit John Journal: J Heart Lung Transplant Date: 2009-09 Impact factor: 10.247