Improving anticoagulation of patients with an implantable left ventricular assist device. Issue 4 (2nd October 2018)

• Record Type: Journal Article
• Authors: Sage, William; Gottiparthy, Amulya; Lincoln, Paul; Tsui, Steven S L; Pettit, Stephen J
• Is Part Of: BMJ open quality. Volume 7:Issue 4(2018)
• Publication Date: 2018-10-02
• Subjects: patient safety -- quality improvement -- audit and feedback; Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2017-000250
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Patients supported with implantable left ventricular assist devices (LVAD) have a significant risk of bleeding and thromboembolic complications. All patients require anticoagulation with warfarin, aiming for a target international normalised ratio (INR) of 2.5 and most patients also receive antiplatelet therapy. We found marked variation in the frequency of INR measurements and proportion of time outside the therapeutic INR range in our LVAD-supported patients. As part of a quality improvement initiative, home INR monitoring and a networked electronic database for recording INR results and treatment decisions were introduced. These changes were associated with increased frequency of INR measurement. We anticipate that changes introduced in this quality improvement project will reduce the likelihood of adverse events during long-term LVAD support.