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Improving anticoagulation of patients with an implantable left ventricular assist device
  1. William Sage,
  2. Amulya Gottiparthy,
  3. Paul Lincoln,
  4. Steven S L Tsui,
  5. Stephen J Pettit
  1. Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr William Sage; was27{at}cam.ac.uk

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.

  • patient safety
  • quality improvement
  • audit and feedback

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors WS and AG: collected data, analysed the data and drafted and revised the manuscript. PL: aided in design of the data collection tools and revised the manuscript. STLT: aided in conception of the project and revised the manuscript. SJP: initiated the project, designed data collection tools, monitored data collection throughout the project, analysed the data and drafted and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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