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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
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Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device

Elisa Vogeler1, Maja-Theresa Dieterlen1, Jens Garbade1

  • 1Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany.

The Thoracic and Cardiovascular Surgeon
|December 1, 2020
PubMed

Insights

International normalized ratio (INR) self-management in left ventricular assist device (LVAD) patients is more effective than telemedical anticoagulation services. Intensive patient training can replace these services for better therapeutic range time.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Clinical Pharmacy

Background:

  • Accurate monitoring of international normalized ratio (INR) is crucial for left ventricular assist device (LVAD) patients to prevent thrombosis and bleeding.
  • Telemedical anticoagulation services (CS) are available to assist with INR management.

Purpose of the Study:

  • To compare the effectiveness of telemedical anticoagulation services (CS) versus regular medical care (RMC) in managing INR for LVAD patients.
  • To determine if telemedicine supervision improves time in therapeutic range (TTR) for anticoagulation.

Main Methods:

  • A comparative study of 30 LVAD patients (15 in CS group, 15 in RMC group) over 12 months.
  • All patients received self-management training for phenprocoumon medication.
  • INR values and patient satisfaction/psychological well-being were documented.

Main Results:

  • The RMC group achieved a significantly higher TTR (78.1%) compared to the CS group (58.3%, p=0.03).
  • Patient satisfaction and psychological well-being were comparable between the RMC and CS groups.
  • 1,798 INR measurements were analyzed.

Conclusions:

  • INR self-management, supported by intensive training, is more efficient for post-LVAD anticoagulation than telemedical services.
  • Experienced staff training can effectively substitute for telemedical anticoagulation services in LVAD patients.
Abstract

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