Open AccessInternational Analysis of LVAD Point-of-Care Versus Plasma INR: A Multicenter Study
Author(s) -
Sarah Schettle,
Thomas Schlöglhofer,
Daniel Zimpfer,
Heinrich Schima,
Friedrich Kaufmann,
A. Salimbangon,
Jennifer Wolforth,
Sarah E. Schroeder,
Rachel Hards,
Brianne M. Ritchie,
Linda L. Staley,
Naveen L. Pereira,
Sudhir S. Kushwaha,
Simon Maltais,
John M. Stulak
Publication year - 2018
Publication title -
asaio journal
Language(s) - English
Resource type - Journals
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/mat.0000000000000845
Subject(s) - medicine , ventricular assist device , cardiology , point of care , population , multicenter study , significant difference , implant , mean difference , cohort , coagulopathy , thrombosis , surgery , heart failure , confidence interval , randomized controlled trial , nursing , environmental health
International normalized ratio (INR) measurements manage risks of bleeding and clotting sequelae in the population with left ventricular assist device (LVAD). Studies suggest that point-of-care (POC) INR does not significantly differ from plasma INR (P-INR) values in other patient populations, although this has not been validated in a multicenter LVAD study. We sought to determine whether POC-INR and P-INR values differ significantly in the LVAD population and reviewed patients with permanent LVAD implantation at seven institutions internationally. Our cohort comprised of 279 paired POC-INR and P-INR checks in patients supported on average 630 ± 598 days postimplant with predominately HeartWare, HeartMate II, and HeartMate III devices. The population averaged 57.9 years of age, and there were 86.7% male. We found no statistically significant difference between POC-INR and P-INR values. International normalized ratio accuracy correlated weakly with the time between INR measurements (p < 0.001). When the time difference was less than 4 hours, the difference between INR pairs was significantly lower than measurements greater than 8 hours (p = 0.006). There was no statistically significant difference when comparing paired INR values and time after implant to INR check (p = 0.43), age (p = 0.12), known coagulopathy (p = 0.12), bleeding history (p = 0.22), or thrombosis history (p = 0.34). This is the first large multicenter international study comparing POC-INR and P-INR measurements in patients with LVAD and found no statistically significant difference between either methods, particularly when measured within less than 4 hours of each other.