TY - JOUR
T1 - International Analysis of LVAD Point-of-Care Versus Plasma INR
T2 - A Multicenter Study
AU - Schettle, Sarah
AU - Schlöglhofer, Thomas
AU - Zimpfer, Daniel
AU - Schima, Heinrich
AU - Kaufmann, Friedrich
AU - Salimbangon, Anthony
AU - Wolforth, Jennifer
AU - Schroeder, Sarah
AU - Hards, Rachel
AU - Ritchie, Brianne
AU - Staley, Linda
AU - Pereira, Naveen
AU - Kushwaha, Sudhir
AU - Maltais, Simon
AU - Stulak, John
N1 - Publisher Copyright:
Copyright © 2018 by the ASAIO
PY - 2018/11/1
Y1 - 2018/11/1
N2 - International normalized ratio (INR) measurements manage risks of bleeding and clotting sequelae in the population with left ventricular assist device (LVAD). Studies suggest that point-of-care (POC) INR does not significantly differ from plasma INR (P-INR) values in other patient populations, although this has not been validated in a multicenter LVAD study. We sought to determine whether POC-INR and P-INR values differ significantly in the LVAD population and reviewed patients with permanent LVAD implantation at seven institutions internationally. Our cohort comprised of 279 paired POC-INR and P-INR checks in patients supported on average 630±598 days postimplant with predominately HeartWare, HeartMate II, and HeartMate III devices. The population averaged 57.9 years of age, and there were 86.7% male. We found no statistically significant difference between POC-INR and P-INR values. International normalized ratio accuracy correlated weakly with the time between INR measurements (p < 0.001). When the time difference was less than 4 hours, the difference between INR pairs was significantly lower than measurements greater than 8 hours (p = 0.006). There was no statistically significant difference when comparing paired INR values and time after implant to INR check (p = 0.43), age (p = 0.12), known coagulopathy (p = 0.12), bleeding history (p = 0.22), or thrombosis history (p = 0.34). This is the first large multicenter international study comparing POC-INR and P-INR measurements in patients with LVAD and found no statistically significant difference between either methods, particularly when measured within less than 4 hours of each other.
AB - International normalized ratio (INR) measurements manage risks of bleeding and clotting sequelae in the population with left ventricular assist device (LVAD). Studies suggest that point-of-care (POC) INR does not significantly differ from plasma INR (P-INR) values in other patient populations, although this has not been validated in a multicenter LVAD study. We sought to determine whether POC-INR and P-INR values differ significantly in the LVAD population and reviewed patients with permanent LVAD implantation at seven institutions internationally. Our cohort comprised of 279 paired POC-INR and P-INR checks in patients supported on average 630±598 days postimplant with predominately HeartWare, HeartMate II, and HeartMate III devices. The population averaged 57.9 years of age, and there were 86.7% male. We found no statistically significant difference between POC-INR and P-INR values. International normalized ratio accuracy correlated weakly with the time between INR measurements (p < 0.001). When the time difference was less than 4 hours, the difference between INR pairs was significantly lower than measurements greater than 8 hours (p = 0.006). There was no statistically significant difference when comparing paired INR values and time after implant to INR check (p = 0.43), age (p = 0.12), known coagulopathy (p = 0.12), bleeding history (p = 0.22), or thrombosis history (p = 0.34). This is the first large multicenter international study comparing POC-INR and P-INR measurements in patients with LVAD and found no statistically significant difference between either methods, particularly when measured within less than 4 hours of each other.
KW - Home INR
KW - LVAD
KW - LVAD anticoagulation
KW - LVAD point of care INR
KW - LVAD warfarin
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U2 - 10.1097/MAT.0000000000000845
DO - 10.1097/MAT.0000000000000845
M3 - Article
C2 - 30199385
AN - SCOPUS:85056277162
SN - 1058-2916
VL - 64
SP - E161-E165
JO - ASAIO Journal
JF - ASAIO Journal
IS - 6
ER -