Development of an Outpatient Guideline for Optimal Anticoagulation Bridging in Patients With Durable Mechanical Circulatory Support

Levesque, Amy; Rimsans, Jessica; Sylvester, Katelyn W.; Lyons, Erin; Frankel, K.A.; Coakley, Lara; Hickey, Mark; Montoya, K.; Mehra, Mandeep R.; Givertz, Michael M.; Stewart, Garrick C.; Connors, Jean M.

doi:10.1097/hpc.0000000000000131

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…For routine outpatient management, the guideline outlines standard INR and lactate dehydrogenate (LDH) testing frequency, gives instructions for when the AHD/MCS team should be contacted and provides links to other LVAS-specific and general anticoagulation-related hospital guidelines including management of critically high and low INRs and strategies for bridging during subtherapeutic INRs. 23 The guideline addresses anticoagulation strategies for specific scenarios such as management of antiplatelet agents surrounding bleeding events and specific recommendations for patients requiring right heart catheterizations or routine colonoscopies. Finally, the guideline provides management recommendations for patients with threatened or confirmed pump thrombosis (Table 2; Supplementary Material Appendix A).…”

Section: Methodsmentioning

confidence: 99%

“…For critically low INRs, we have created (and previously published) a detailed guideline and associated workflow to facilitate standardization and communication between all clinicians involved in a patient’s care. 23 The recommendations adjust the management strategy for new implants versus those implanted more than 3 months prior to the event. They also provide different recommendations for patients with a history of bleeding or thrombotic events.…”

Section: Methodsmentioning

confidence: 99%

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Development of Multidisciplinary Anticoagulation Management Guidelines for Patients Receiving Durable Mechanical Circulatory Support

Levesque

Lewin

Rimsans

et al. 2019

Clin Appl Thromb Hemost

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Patients receiving durable mechanical circulatory support (MCS) require life-long anticoagulation with a vitamin K antagonist (VKA). Due to alternations in hemostasis, concomitant therapy with antiplatelet agents and critical illness, they are at increased risk of thromboembolic and bleeding complications compared with the general population managed on VKAs. To prevent thrombotic events, current guidelines recommend that patients with MCS receive long-term anticoagulation with a VKA to maintain a target international normalized ratio (INR) as specified by device manufacturers, but limited data exist regarding specific routine management of anticoagulation therapy and its potential complications. To optimize anticoagulation management and minimize risk in these patients, we have centralized anticoagulation management in a collaborative approach between the inpatient hemostatic and antithrombotic (HAT) stewardship service and between ambulatory anticoagulation management service (AMS) and the advanced heart disease team. Patients are followed by these three services beginning when the device is implanted and extending the duration that patients have the device. The teams include multiple clinicians from cardiac surgery, cardiology, hematology, pharmacy, nursing, case management, nutrition, and psychiatry, therefore, in order to standardize practice among clinicians without compromising patient centered decision making, we assembled an interdisciplinary team to create multiple treatment guidelines. In addition to a centralized and collaborative approach, our guidelines ensure seamless transitions of care between the inpatient and outpatient settings. We believe our approach has demontrated a positive improvement in the care of these challenging patients. In this article, we present our comprehensive centralized anticoagulation management approach for patients with left ventricular assist systems (LVAS).

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Development of Multidisciplinary Anticoagulation Management Guidelines for Patients Receiving Durable Mechanical Circulatory Support

Levesque

Lewin

Rimsans

et al. 2019

Clin Appl Thromb Hemost

Self Cite

View full text Add to dashboard Cite

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Development of an Institutional Periprocedural Management Guideline for Oral Anticoagulants

Lewin

Collins

Sylvester

et al. 2020

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Patients on oral anticoagulation commonly undergo surgery or other invasive procedures. Periprocedural management of oral anticoagulants involves a careful balance of the thromboembolic risk and bleeding risk. To standardize clinical practice at our institution, we developed a guideline for periprocedural management for patients taking oral anticoagulants that incorporates published data and expert opinion. In this article, we present our clinical practice guideline as a decision support tool to aid clinicians in developing a consistent strategy for managing periprocedural anticoagulation and for safely bridging anticoagulation in patients who require it.

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Development of an Outpatient Guideline for Optimal Anticoagulation Bridging in Patients With Durable Mechanical Circulatory Support

Cited by 2 publications

References 22 publications

Development of Multidisciplinary Anticoagulation Management Guidelines for Patients Receiving Durable Mechanical Circulatory Support

Development of Multidisciplinary Anticoagulation Management Guidelines for Patients Receiving Durable Mechanical Circulatory Support

Development of an Institutional Periprocedural Management Guideline for Oral Anticoagulants

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