Maximising Time In Therapeutic Range With Vitamin K Antagonists In Lvad Patients

Purpose Time in Therapeutic range (TTR) is the percentage of time an anticoagulated patient has an INR between 2-3. While studies have demonstrated a link between low TTR, bleeding and thrombosis, the mean TTR in a VAD population is between 45 and 65%. We implemented a new anticoagulation protocol using point of care devices (POC, coagucheck©), with patient education and empowerment to control their own VKA (vitamin K antagonist) dosing. Methods Before discharge all VAD patients received anticoagulation education including drug and food interaction. Depending on INR stability, patients measured INR every 2-3 days and sent a text message to the VAD team for the appropriate VKA dose. After a minimum of 2 months post VAD, if the patient and team felt comfortable, VKA dosing was delegated to the patient. Patients updated the team weekly. Results Between February and October 2020, 24 patients were included (29% HM3, 71% HW, one Bi-VAD (HW)). Median follow-up was 131 days (IQR 88-163), cumulative follow up time was 3087day or 8.5 years. Median TTR was 90% (IQR 83-97), median INR 2.41 (IQR 2.2-2.4). INR was measured 3.6 times / week (IQR 3.3-3.8). In 15 cases (62%), the VKA dosing decision was delegated to the patient. Median TTR during patient management (96%, IQR 90-97) was significantly higher than the TTR during medical control (83%, IQR 78-88) (P Conclusion A TTR higher than described in the literature is achievable in VAD patients using a POC device. If prerequisites are met, VAD patients can be empowered to control their VKA dosing with excellent TTR.