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Introduction: Patients with a continuous-flow left ventricular assist device (CF-LVAD) require anticoagulation with a vitamin K antagonist to prevent thromboembolic events. Fluctuations in the international normalized ratio are associated with both increased thrombotic and bleeding episodes. To date, risk factors for low time in therapeutic range (TTR) among ambulatory patients with a CF-LVAD have not been explored.

Methods: A retrospective single-center analysis of 121 patients implanted with a CF-LVAD was performed. International normalized ratios were systematically recorded from the initial postdischarge outpatient visit to 12 months of time on the device. Risk factors for low TTR were evaluated using a multivariable linear regression analysis. Each of the 21 independent variables was entered into a stepwise regression designed to minimize the Akaike information criteria.

Results: In the multivariable analysis, the model output revealed that every 1-year increase in age was associated with a 0.4% increase in TTR (p=0.008), and every 1 mile further from clinic was associated with a 0.08% increase in TTR (p=0.03). Female sex was associated with a 10.1% decrease in TTR (p=0.04), type 2 diabetes was associated with an 11.5% decrease in TTR (p=0.006), and prior warfarin use was associated with an 8.3% decrease in TTR (p=0.03).

Conclusion: In CF-LVAD recipients receiving warfarin, increasing age and distance from clinic are independent predictors of higher TTR. Female sex, type 2 diabetes, and prior warfarin use are independent predictors of lower TTR.

Titel:	Predictors of Warfarin Time in Therapeutic Range after Continuous-Flow Left Ventricular Assist Device.
Autor/in / Beteiligte Person:	Henderson, JB ; Iyer, P ; Coniglio, AC ; Katz, JN ; Chien, C ; Hollis, IB
Link:	Zum Volltext
Zeitschrift:	Pharmacotherapy, Jg. 39 (2019-10-01), Heft 10, S. 1030-1035
Veröffentlichung:	2012- : Malden, MA : Wiley-Blackwell ; <i>Original Publication</i>: [Carlisle, MA : Pharmacotherapy Publications, c1981-, 2019
Medientyp:	academicJournal
ISSN:	1875-9114 (electronic)
DOI:	10.1002/phar.2324
Schlagwort:	Aged Anticoagulants administration & dosage Anticoagulants adverse effects Blood Coagulation drug effects Diabetes Mellitus, Type 2 epidemiology Female Hemorrhage chemically induced Humans Male Middle Aged Retrospective Studies Risk Adjustment methods Risk Factors Sex Factors Thromboembolism etiology Heart-Assist Devices adverse effects Hemorrhage prevention & control International Normalized Ratio methods International Normalized Ratio statistics & numerical data Thromboembolism prevention & control Warfarin administration & dosage Warfarin adverse effects
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Pharmacotherapy] 2019 Oct; Vol. 39 (10), pp. 1030-1035. <i>Date of Electronic Publication: </i>2019 Oct 07. MeSH Terms: International Normalized Ratio* / methods ; International Normalized Ratio* / statistics & numerical data ; Warfarin* / administration & dosage ; Warfarin* / adverse effects ; Heart-Assist Devices / adverse effects ; Hemorrhage / prevention & control ; Thromboembolism / *prevention & control ; Aged ; Anticoagulants / administration & dosage ; Anticoagulants / adverse effects ; Blood Coagulation / drug effects ; Diabetes Mellitus, Type 2 / epidemiology ; Female ; Hemorrhage / chemically induced ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Adjustment / methods ; Risk Factors ; Sex Factors ; Thromboembolism / etiology References: Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant 2013;32(2):157-87. ; Boehme AK, Pamboukian SV, George JF, et al. Anticoagulation control in patients with ventricular assist devices. ASAIO J 2017;63(6):759-65. ; Halder LC, Richardson LB, Garberich RF, Zimbwa P, Bennett MK. Time in therapeutic range for left ventricular assist device patients anticoagulated with warfarin: a correlation to clinical outcomes. ASAIO J 2017;63(1):37-40. ; Nassif ME, LaRue SJ, Raymer DS, et al. Relationship between anticoagulation intensity and thrombotic or bleeding outcomes among outpatients with continuous-flow left ventricular assist devices. Circ Heart Fail 2016;9(5):1-6. https://doi.org/10.1161/circheartfailure.115.002680. ; Baumann Kreuziger LM, Kim B, Wieselthaler GM. Antithrombotic therapy for left ventricular assist devices in adults: a systematic review. J Thromb Haemost 2015;13(6):946-55. ; Witt DM, Delate T, Clark NP, et al. Outcomes and predictors of very stable INR control during chronic anticoagulation therapy. Blood 2009;114(5):952-6. ; Rose AJ, Hylek EM, Ozonoff A, Ash AS, Reisman JI, Berlowitz DR. Patient characteristics associated with oral anticoagulation control: results of the Veterans AffaiRs Study to Improve Anticoagulation (VARIA): patient-level predictors of anticoagulation control. J Thromb Haemost 2010;8(10):2182-91. ; Razouki Z, Ozonoff A, Zhao S, Rose AJ. Pathways to poor anticoagulation control. J Thromb Haemost 2014;12(5):628-34. ; Singer DE, Hellkamp AS, Piccini JP, et al. Impact of global geographic region on time in therapeutic range on warfarin anticoagulant therapy: data from the ROCKET AF clinical trial. J Am Heart Assoc 2013;2(1):e000067. ; Rosendaal FR, Cannegieter SC, van der Meer FJ, Briët E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993;69(3):236-9. ; Kang G, Ha R, Banerjee D. Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant 2016;35(1):67-73. ; Singh GK, Siahpush M. Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998. Int J Epidemiol 2002;31(3):600-13. ; Bass PF, Wilson JF, Griffith CH. A shortened instrument for literacy screening. J Gen Intern Med 2003;18(12):1036-8. ; Maldonado JR, Dubois HC, David EE, et al. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. Psychosomatics 2012;53(2):123-32. ; Rose AJ, Ozonoff A, Henault LE, Hylek EM. Warfarin for atrial fibrillation in community-based practise. J Thromb Haemost 2008;6(10):1647-54. Contributed Indexing: Keywords: heart assist device; international normalized ratio; time in therapeutic range; warfarin Substance Nomenclature: 0 (Anticoagulants) ; 5Q7ZVV76EI (Warfarin) Entry Date(s): Date Created: 20190830 Date Completed: 20200724 Latest Revision: 20200724 Update Code: 20240513

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Predictors of Warfarin Time in Therapeutic Range after Continuous-Flow Left Ventricular Assist Device.