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Relationship Between Anticoagulation Intensity and Thrombotic or Bleeding Outcomes Among Outpatients With

Michael E Nassif1, Shane J LaRue2, David S Raymer1

  • 1From the Division of Cardiology, Department of Medicine (M.E.N., S.J.L., E.N., J.M.V., G.A.E.) and Department of Medicine (D.S.R., B.F.G.), Washington University School of Medicine, St. Louis, MO.

Circulation. Heart Failure
|May 8, 2016
PubMed

Insights

Lowering anticoagulation intensity (INR) below 2.0 in continuous-flow left ventricular assist device (CF-LVAD) patients increases thrombotic events. Optimal INR for CF-LVAD patients is 2.6 to balance risks.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Device Technology

Background:

  • Continuous-flow left ventricular assist devices (CF-LVADs) are crucial for heart failure management.
  • Previous research suggested lower target International Normalized Ratio (INR) values (<2.5) for CF-LVAD patients.
  • Recent data indicate a rise in pump thrombosis, particularly within six months post-implantation.

Purpose of the Study:

  • To evaluate thrombotic and bleeding outcomes in CF-LVAD patients based on anticoagulation intensity.
  • To determine the relationship between INR levels and adverse events in CF-LVAD recipients.
  • To identify an optimal INR range for managing CF-LVAD patients.

Main Methods:

  • Retrospective review of 249 CF-LVAD outpatients (January 2005 - August 2013).
  • Analysis of 10,927 INR measurements using Poisson models to assess event rates.
  • Multivariate Cox proportional hazard models adjusted for clinical factors.

Main Results:

  • During a mean follow-up of 17.6 months, 46 thrombotic events occurred.
  • Highest thrombotic event rates were observed at INR <1.5 (0.40 events/patient-year) and 1.5-1.99 (0.16 events/patient-year).
  • INR was inversely associated with thrombotic events (HR 0.40; P=0.002); optimal INR was 2.6.

Conclusions:

  • INR is inversely related to thrombotic events in CF-LVAD patients.
  • INR values below 2.0 are associated with increased thrombotic events.
  • An INR of 2.6 is suggested as optimal for balancing thrombotic and bleeding risks in CF-LVAD patients.
Abstract

Keywords:
atrial fibrillationfollow-up studieshemorrhageinternational normalized ratio stroke

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