Benefit Of Self-Managed Anticoagulation In Patients With Left Ventricular Assist Device

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 TTR (Rosendaal) was higher in patients undergoing RMC (78.114.3%) 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.