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

Abstract

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.