Benefit of self-managed anticoagulation in patients with left ventricular assist device
<p> <b>Background</b> The exact monitoring of the therapeutic-range international normalized ratio (INR) after left ventricular assist device (LVAD) implantation is an important aim to reduce the risk of thrombosis or bleeding complications. Service providers offer a telemedical an...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2021
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| In: |
The thoracic and cardiovascular surgeon
Year: 2021, Volume: 69, Issue: 6, Pages: 518-525 |
| ISSN: | 1439-1902 |
| DOI: | 10.1055/s-0040-1719153 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1055/s-0040-1719153 Verlag, lizenzpflichtig, Volltext: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1719153 
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| Author Notes: | Elisa Vogeler, Maja-Theresa Dieterlen, Jens Garbade, Sven Lehmann, Khalil Jawad, Michael A. Borger, Anna L. Meyer |
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| 520 | |a <p> <b>Background</b> The exact monitoring of the therapeutic-range international normalized ratio (INR) after left ventricular assist device (LVAD) implantation is an important aim to reduce the risk of thrombosis or bleeding complications. Service providers offer a telemedical anticoagulation service (CS).</p> <p> <b>Methods</b> We compared LVAD patients using the CS (<i>n</i> = 15) to those who received regular medical care (RMC; <i>n</i> = 15) to investigate if telemedicine supervision increased the INR-specific time in the therapeutic range (TTR) during anticoagulation. All patients received self-management training for phenprocoumon medication according to their INR value. INR values were documented for 12 months. A survey (scale: 1 = not satisfied and 10 = very satisfied) was used to determine patient's satisfaction and psychological well-being.</p> <p> <b>Results</b> A total of 1,798 INR measurements were analyzed. The TTR<sub>Rosendaal</sub> was higher in patients undergoing RMC (78.1 ± 14.3%) compared with that in patients using the CS (58.3 ± 28.0%, <i>p</i> = 0.03). The patient's satisfaction with the coagulation setting at the beginning of the study (RMC: 6.7 ± 3.1, CS: 7.2 ± 3.0, <i>p</i> = 0.74) and psychological wellbeing (RMC: 6.5 ± 1.9, CS: 6.5 ± 2.7, <i>p</i> = 0.97) were comparable between both groups.</p> <p> <b>Conclusion</b> We found that INR self-management is superior regarding the efficiency of post-LVAD anticoagulation therapy when compared with telemedical (CS)-based INR management in a small study cohort. Intensive training by experienced staff was able to replace CS.</p> | ||
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