Evaluation of adjusted international normalized ratio goal in patients with HeartMate 3 left ventricular assist devices

Amanda Sowder, Ayesha Ather, Emma Birks, Andrew Kolodziej, Rajasekhar Malyala, Adam Sieg, Aric Schadler, Rachel Unger, Maya Guglin, William Kuan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The HeartMate3 left ventricular assist device (HM3 LVAD) has shown a low incidence of thrombosis, but bleeding risk is as high as 43%. We aim to describe the impact of lower international normalization ratio (INR) goal on clinical outcomes. Methods: In February 2019, our tertiary care institution lowered INR goal in HM3 patients from manufacturer recommendations to 1.8–2.2 and retrospectively analyzed the data. Two cohorts were compared: patients with lower INR goal upon implant (De novo) and those with subsequently lowered INR goal (Adjusted). The Adjusted group also served as its own historical control. Both groups continued aspirin 81 milligrams daily per manufacturer recommendations. The primary outcomes were incidences of bleed and thrombosis events within 12 months. Secondary outcomes included survival free of disabling stroke or reoperation to remove or replace the device and Rosendaal time in therapeutic range (TTR) over 12 months. Results: Thirty-one patients were evaluated for inclusion with 26 meeting criteria. Within 12 months, incidence of bleeding events was 25% and 28.6% in the De novo and Adjusted groups, respectively. Incidence of thrombotic events within 12 months was 0% in the De novo group and 7.1% in the Adjusted group. Twelve-month survival free of disabling stroke or reoperation to remove or replace the device was higher over 12 months for patients in the De novo group (91.7% vs. 78.6%). Median 12-month TTR was 36%, which was primarily attributable to subtherapeutic deviations. Conclusions: A lower INR goal may be safe when initiated De novo following implantation of the HM3. This study informs the need for larger prospective studies.

Original languageEnglish
Pages (from-to)1613-1621
Number of pages9
JournalArtificial Organs
Volume47
Issue number10
DOIs
StatePublished - Oct 2023

Bibliographical note

Publisher Copyright:
© 2023 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.

Keywords

  • advanced heart failure
  • anticoagulation
  • left ventricular assist device
  • warfarin

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

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