Home INR Monitoring: Does It Help Reduce the Chance of Re-Admission for LVAD Patients?

Abstract

Purpose Anticoagulation therapy in Continuous Flow (CF) Left Ventricular Assist Device (LVAD) pts continues to be challenging due to high frequency of Gastrointestinal (GI) bleeding and device thrombosis. This study sought to determine if using a Home INR Machine (HINRM) will reduce the risk of these complications. Methods and Materials All pts monitored by HINRM during LVAD support were enrolled. Data on anticoagulation regimen and device related complications were collected. Results 14 CF-LVAD pts who have used or currently use HINRM were identified. Mean age was 68 ± 11 years old, 86% were male and 57% were destination therapy. 86% (n=12) were compliant and their INR was maintained within therapeutic range 67±24% of the time. The INR values were reported on average once every 9.2 ± 5.3 days. While not using HINRM (386±367 days), 43% (n=6) of these pts were readmitted for GI bleeding (4 pts), device thrombosis (1 pt) and epistaxis (1 pt). While using HINRM (376±250 days), 21% (n=3) of these pts were readmitted for 3 cases of GI bleeding, 1 case of epistaxis and none from DT. Two of the GI bleeding cases occurred during a 3-month period of non-compliance from a single pt. The total event rate was reduced from 0.41 to 0.28 events/person-year, respectively. Conclusions Our data suggests that self-monitoring with HINRM among CF-LVAD pts is a feasible form of maintaining adequate INR range with good compliance. Lower readmission rate for GI bleeding and device thrombosis was noted after using HINRM than prior. Larger cohorts with longer follow up times are warranted. [ figure 1 ]