title: Assessing Anticoagulation Practice Patterns in Patients on Durable Mechanical Circulatory Support Devices: An International Survey.
abstract: Anticoagulation in mechanical circulatory support (MCS) patients dictated by local practice, and therefore uniform standards for management are lacking. To characterize the worldwide variance in anticoagulation and antiplatelet therapy in patients with MCS devices, a 42 item survey was created and distributed electronically in August 2014. The survey assessed the center-perceived thromboembolic risk (minimal, low, moderate, or high) and characterized the antiplatelet and anticoagulant strategies for the Thoratec HeartMate II (HMII) and HeartWare HVAD (HVAD). A total of 83/214 centers (39%) responded: North America (60/152), Europe (18/50), Australia (2/4), and Asia (3/8). Although the most common target international normalized ratio (INR) was 2-3 for both devices, significant variability exists. Anticoagulation intensity tended to be lower with the HMII, with more centers targeting INR values of less than 2.5. Aspirin monotherapy was the most common antiplatelet regimen; however, the HVAD patients were more likely to be on daily aspirin doses over 100 mg. In addition, parenteral bridging was more frequent with the HVAD device. While 43.8% of respondents indicated an increase in the perceived risk of HMII device thrombosis in 2014, intensification of anticoagulation (22%) or antiplatelet (11%) therapy was infrequent. Our findings verify the wide variety of anticoagulation practice patterns between MCS centers.
authors: From the *Department of Pharmacy, New York Presbyterian Columbia University Medical Center, New York, New York; †Department of Pharmacy, Allegheny General Hospital, Pittsburgh, Pennsylvania; ‡Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Middlesex, United Kingdom; §Department of Cardiothoracic Surgery, University of Miami, Miami, Florida; ¶Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ‖Nova Southeastern University, Ft. Lauderdale, Florida; and #Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust.
authors: Douglas L
authors: DL
authors: Jennings
authors: Edward T
authors: ET
authors: Horn
authors: Haifa
authors: H
authors: Lyster
authors: Anthony L
authors: AL
authors: Panos
authors: Jeffrey J
authors: JJ
authors: Teuteberg
authors: Hans B
authors: HB
authors: Lehmkuhl
authors: Alexandra
authors: A
authors: Perez
authors: Michael A
authors: MA
authors: Shullo
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D019538:Health Care Surveys; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors