Abstract
Anticoagulation in mechanical circulatory support (MCS) patients dictated by local practice, and therefore uniform standards for management are lacking. To characterize the worldwide variance in anticoagulation and antiplatelet therapy in patients with MCS devices, a 42 item survey was created and distributed electronically in August 2014. The survey assessed the center-perceived thromboembolic risk (minimal, low, moderate, or high) and characterized the antiplatelet and anticoagulant strategies for the Thoratec HeartMate II (HMII) and HeartWare HVAD (HVAD). A total of 83/214 centers (39%) responded: North America (60/152), Europe (18/50), Australia (2/4), and Asia (3/8). Although the most common target international normalized ratio (INR) was 2-3 for both devices, significant variability exists. Anticoagulation intensity tended to be lower with the HMII, with more centers targeting INR values of less than 2.5. Aspirin monotherapy was the most common antiplatelet regimen; however, the HVAD patients were more likely to be on daily aspirin doses over 100 mg. In addition, parenteral bridging was more frequent with the HVAD device. While 43.8% of respondents indicated an increase in the perceived risk of HMII device thrombosis in 2014, intensification of anticoagulation (22%) or antiplatelet (11%) therapy was infrequent. Our findings verify the wide variety of anticoagulation practice patterns between MCS centers.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 28-32 |
| Number of pages | 5 |
| Journal | ASAIO Journal |
| Volume | 62 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2016 |
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Keywords
- Anticoagulation
- Device Thrombosis
- Mechanical Circulatory Support
- Practice Variance
- Stroke
ASJC Scopus subject areas
- Biophysics
- Biomaterials
- Bioengineering
- Biomedical Engineering
- Medicine(all)
Cite this
Assessing anticoagulation practice patterns in patients on durable mechanical circulatory support devices : An international survey. / Jennings, Douglas L.; Horn, Edward T.; Lyster, Haifa; Panos, Anthony L.; Teuteberg, Jeffrey J.; Lehmkuhl, Hans B.; Perez, Alexandra; Shullo, Michael A.
In: ASAIO Journal, Vol. 62, No. 1, 2016, p. 28-32.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Assessing anticoagulation practice patterns in patients on durable mechanical circulatory support devices
T2 - An international survey
AU - Jennings, Douglas L.
AU - Horn, Edward T.
AU - Lyster, Haifa
AU - Panos, Anthony L.
AU - Teuteberg, Jeffrey J.
AU - Lehmkuhl, Hans B.
AU - Perez, Alexandra
AU - Shullo, Michael A.
PY - 2016
Y1 - 2016
N2 - Anticoagulation in mechanical circulatory support (MCS) patients dictated by local practice, and therefore uniform standards for management are lacking. To characterize the worldwide variance in anticoagulation and antiplatelet therapy in patients with MCS devices, a 42 item survey was created and distributed electronically in August 2014. The survey assessed the center-perceived thromboembolic risk (minimal, low, moderate, or high) and characterized the antiplatelet and anticoagulant strategies for the Thoratec HeartMate II (HMII) and HeartWare HVAD (HVAD). A total of 83/214 centers (39%) responded: North America (60/152), Europe (18/50), Australia (2/4), and Asia (3/8). Although the most common target international normalized ratio (INR) was 2-3 for both devices, significant variability exists. Anticoagulation intensity tended to be lower with the HMII, with more centers targeting INR values of less than 2.5. Aspirin monotherapy was the most common antiplatelet regimen; however, the HVAD patients were more likely to be on daily aspirin doses over 100 mg. In addition, parenteral bridging was more frequent with the HVAD device. While 43.8% of respondents indicated an increase in the perceived risk of HMII device thrombosis in 2014, intensification of anticoagulation (22%) or antiplatelet (11%) therapy was infrequent. Our findings verify the wide variety of anticoagulation practice patterns between MCS centers.
AB - Anticoagulation in mechanical circulatory support (MCS) patients dictated by local practice, and therefore uniform standards for management are lacking. To characterize the worldwide variance in anticoagulation and antiplatelet therapy in patients with MCS devices, a 42 item survey was created and distributed electronically in August 2014. The survey assessed the center-perceived thromboembolic risk (minimal, low, moderate, or high) and characterized the antiplatelet and anticoagulant strategies for the Thoratec HeartMate II (HMII) and HeartWare HVAD (HVAD). A total of 83/214 centers (39%) responded: North America (60/152), Europe (18/50), Australia (2/4), and Asia (3/8). Although the most common target international normalized ratio (INR) was 2-3 for both devices, significant variability exists. Anticoagulation intensity tended to be lower with the HMII, with more centers targeting INR values of less than 2.5. Aspirin monotherapy was the most common antiplatelet regimen; however, the HVAD patients were more likely to be on daily aspirin doses over 100 mg. In addition, parenteral bridging was more frequent with the HVAD device. While 43.8% of respondents indicated an increase in the perceived risk of HMII device thrombosis in 2014, intensification of anticoagulation (22%) or antiplatelet (11%) therapy was infrequent. Our findings verify the wide variety of anticoagulation practice patterns between MCS centers.
KW - Anticoagulation
KW - Device Thrombosis
KW - Mechanical Circulatory Support
KW - Practice Variance
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84952714706&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84952714706&partnerID=8YFLogxK
U2 - 10.1097/MAT.0000000000000274
DO - 10.1097/MAT.0000000000000274
M3 - Article
AN - SCOPUS:84952714706
VL - 62
SP - 28
EP - 32
JO - ASAIO Journal
JF - ASAIO Journal
SN - 1058-2916
IS - 1
ER -