Impact of time in therapeutic range after left ventricular assist device placement: a comparison between thrombus and thrombus-free periods

Lea, Julia C; Floroff, Catherine; Ingemi, Amanda I.; Zeevi, Gary R.

doi:10.1007/s11239-018-01800-x

Cited by 14 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Researchers identified a TTR of <50% to be associated with a HR of 2.91 (95% CI 1.18–7.14, p = 0.02) for thromboembolism in 127 HeartMate II or HeartWare HVAD patients at a single center, 36 and further identified that TTR >60% was associated with both decreased risk of thromboembolism (HR 0.37, 95% CI 0.14–0.96, p = 0.042) as well as hemorrhage (HR 0.45, 95% CI 0.21–0.98, p = 0.045) compared to those with TTR <50% 37 . When used as their own control, 25 HeartMate II and HeartWare HVAD recipients exhibited an 11.4% lower TTR in the 1 month preceding pump thrombosis or ischemic stroke compared to the 6 month event‐free previous period 38 . In 51 HeartMate II or HeartWare HVAD recipients, those with bleeding events spent a higher proportion of time above INR goal in the preceding month than those with thrombotic events (41% vs. 17%; p = 0.007) 39 …”

Section: Chronic Outpatient Managementmentioning

confidence: 99%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

View full text Add to dashboard Cite

Left ventricular assist devices (LVADs) have revolutionized the care of patients with advanced heart failure, yet still require concomitant medications in order to achieve the best possible clinical outcomes. Since the outset of routine placement of durable, continuous‐flow LVADs, much of the medication management of these patients to date has been based on International Society of Heart and Lung Transplantation (ISHLT) guidance, most recently published in 2013. Since 2013, numerous multidisciplinary pharmacotherapy publications have increased the LVAD community's understanding of best practices with respect to medications. We identified the major domains of LVAD medication management and conducted a comprehensive search of US National Library of Medicine MEDLINE® database using keywords chosen to identify medication‐related publications of significance dated 2013 or later. Trials pertaining to the HeartMate II™ and the HeartMate™ 3 LVADs (Abbott, Chicago, IL) and the HeartWare™ HVAD™ System (Medtronic, Minneapolis, MN) were chosen for inclusion. Highest priority for inclusion was given to prospective, randomized, controlled studies. Absent these, controlled trials (retrospective or prospective observational) were given next‐highest consideration, followed by retrospective uncontrolled studies, and finally case series. Reference lists of qualified publications were reviewed to find any other publications of interest that were not discovered on initial search. Case reports were generally excluded, except where the insight gained was deemed to be uniquely pertinent. This document serves to provide a comprehensive review of the current understanding of optimal medication management in patients with durable, continuous‐flow LVADs.

show abstract

Section: Chronic Outpatient Managementmentioning

confidence: 99%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

View full text Add to dashboard Cite

show abstract

“…With daily measurements, the patients achieved a mean INR time within the therapeutic range of 70 ± 15%, despite tightly selected thresholds. Taking an extended target range of 2‐3, the daily INR values measured within the target range rose to 94 ± 1% (min 77%, max 100%) which can be rated as very good …”

Section: Discussionmentioning

confidence: 98%

“…Taking an extended target range of 2-3, the daily INR values measured within the target range rose to 94 ± 1% (min 77%, max 100%) which can be rated as very good. 19,20 The photo function within the smartphone application was not used to document the driveline exit site very often. We expect the reasons for this to be the necessity of involving others (eg, carers and family members) and/or fear of infection from using a non-sterile smartphone during a bandage change.…”

Section: Discussionmentioning

confidence: 99%

Improved aftercare in LVAD patients: Development and feasibility of a smartphone application as a first step for telemonitoring

et al. 2019

View full text Add to dashboard Cite

For the success of the treatment with a left ventricular assist device (LVAD), both adequate self‐management by the patient and an optimum level of support from the implanting hospital are crucial. A smartphone application has recently been developed within the framework of a European research project for the close monitoring of LVAD patients in order to improve upon their current aftercare situation. Using this new tool, different relevant parameters (eg, weight, international normalized ratio [INR], medication, LVAD parameters, symptoms, and photos of the driveline exit) can be sent daily or as required to a corresponding clinical application at the hospital for evaluation. The objective of this study was to monitor the functionality, acceptance, and usability of this smartphone application in LVAD patients. Prospective single‐center study: in total, 13 patients (60 ± 7 years, 92% male, 1027 ± 653 days after LVAD implantation) were requested to test the application for approx. 4 weeks. At the end of the study, all entered data were evaluated and the patients were questioned regarding the acceptance and the usability. During the study period of mean 34 ± 8 days, a total of 453 data records (mean 35 ± 7 per patient) arrived at the hospital. In addition, a total of 19 photos of the driveline exit site were also sent via smartphone. The clinical application registered a total of 160 conspicuities. These comprised 126 INR deviations (target range 2.3‐2.8) and 34 symptoms (mainly nosebleeds). The smartphone application functioned reliably, was well received by the patients and was graded highly for acceptance and usability. The results show that smartphone applications can definitely be used to improve aftercare in LVAD therapy in selected patients. Long‐term studies are now needed to investigate the extent to which complications can be prevented, healthcare costs reduced, and quality of life increased.

show abstract

“…In their report, the overall TTR in 51 patients was 52 %. Although an association between TTR and clinical outcomes in patients with an LVAD on chronic warfarin therapy is not well understood, Lea et al investigated 30 thrombotic events in 25 patients [7]. In their study, the TTR (target INR = 2-3) was 11.4% lower 1 month before thrombus than the comparable month in the control period, and they concluded that the risk of thrombosis with lower TTR in the months leading up to thrombus was increased compared to a thrombus-free period.…”

Section: Discussionmentioning

confidence: 99%

Management of anticoagulant therapy using a portable point-of-care international normalized ratio device and social networking service in a patient with a left ventricular assist device

Asaka

Nagashima

Kotooka

et al. 2020

Journal of Cardiology Cases

View full text Add to dashboard Cite

Continuous-flow left ventricular assist devices (CF-LVAD) are increasingly used to support patients with advanced heart failure, both as a bridge to transplantation and destination therapy [1].However, the incidence of serious complications such as device infection and stroke is still high. Anticoagulation therapy is sometimes difficult at the time of infections, so strict control of the prothrombin time-international normalized ratio (PT-INR) is crucial to avoid complications associated with the destabilization of anticoagulant therapy such as pump thrombus, major bleeding, and stroke. Although the self-measurement of PT-INR using a point-of-care (POC) device by patients at home is recommended by the guideline [2], it is not clear who should adjust the dose of warfarin based on the results of this measurement. Therefore, we evaluated the usefulness of a social networking service (SNS) on PT-INR control to complement face-to-face monthly hospital visits.

show abstract

Impact of time in therapeutic range after left ventricular assist device placement: a comparison between thrombus and thrombus-free periods

Cited by 14 publications

References 23 publications

Pharmacotherapy for durable left ventricular assist devices

Pharmacotherapy for durable left ventricular assist devices

Improved aftercare in LVAD patients: Development and feasibility of a smartphone application as a first step for telemonitoring

Management of anticoagulant therapy using a portable point-of-care international normalized ratio device and social networking service in a patient with a left ventricular assist device

Contact Info

Product

Resources

About