Impact of a Nurse-Driven Heparin Monitoring Protocol for Ventricular Assist Devices.

Abstract

Ventricular assist devices require anticoagulation to reduce thrombosis risk. Nurse-driven unfractionated heparin monitoring protocols have been validated for various indications, although data in patients with ventricular assist devices are lacking. To evaluate a nurse-driven protocol for managing unfractionated heparin therapy in stable patients with ventricular assist devices. This was a retrospective analysis of adult patients with ventricular assist devices requiring unfractionated heparin therapy, divided into 2 groups: before and after protocol implementation. The primary outcome was time to first therapeutic activated partial thromboplastin time. Each group included 29 patients. There was no difference between the preintervention and postintervention groups in time to therapeutic activated partial thromboplastin time (25 vs 23 hours, P = .95) or proportion of patients with therapeutic activated partial thromboplastin time within the first 24 hours (45% vs 34%, P = .42). Suspected pump thrombosis and bleeding events were similar in the 2 groups. A nurse-driven heparin monitoring protocol was similar in time to therapeutic activated partial thromboplastin time compared with provider-driven monitoring and adjustments in patients with ventricular assist devices.