Thorac Cardiovasc Surg
DOI: 10.1055/s-0040-1719153
Original Cardiovascular

Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device

Elisa Vogeler
1  Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
,
1  Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
,
Jens Garbade
1  Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
,
Sven Lehmann
1  Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
,
Khalil Jawad
1  Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
,
Michael A. Borger
1  Department for Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
,
Anna L. Meyer
2  Department of Cardiac Surgery, University Hospital, Heidelberg, Germany
› Author Affiliations

Abstract

Background 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).

Methods We compared LVAD patients using the CS (n = 15) to those who received regular medical care (RMC; n = 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.

Results A total of 1,798 INR measurements were analyzed. The TTRRosendaal was higher in patients undergoing RMC (78.1 ± 14.3%) compared with that in patients using the CS (58.3 ± 28.0%, p = 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, p = 0.74) and psychological wellbeing (RMC: 6.5 ± 1.9, CS: 6.5 ± 2.7, p = 0.97) were comparable between both groups.

Conclusion 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.

Note

We presented our work as a poster at the AHA Congress (Chicago, Illinois, United States) in 2018 and as an oral presentation at the DGTHG Congress (Wiesbaden) in 2020.


Authors' Contributions

E.V. is a highly motivated medical student who put much effort in data collection, analysis, data interpretation, as well as manuscript writing and editing. M.T.D. is an experienced researcher who attended, completed, and corrected data analysis, data interpretation, and the manuscript writing and editing. Therefore, and in agreement with the coauthors, a shared first authorship is justified.


Both authors contributed equally to this work.




Publication History

Received: 01 September 2020

Accepted: 23 September 2020

Publication Date:
01 December 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany