151. International Analysis of LVAD Point-of-Care Versus Plasma INR: A Multicenter Study
- Author
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Linda L. Staley, Naveen L. Pereira, Sudhir S. Kushwaha, Heinrich Schima, Simon Maltais, Thomas Schlöglhofer, Jennifer Wolforth, Sarah Schettle, Sarah E. Schroeder, John M. Stulak, Brianne M. Ritchie, Daniel Zimpfer, Friedrich Kaufmann, R. Hards, and A. Salimbangon
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,Point-of-Care Systems ,medicine.medical_treatment ,Population ,Biomedical Engineering ,Biophysics ,Bioengineering ,030204 cardiovascular system & hematology ,Cohort Studies ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,health services administration ,Internal medicine ,Coagulopathy ,medicine ,Humans ,heterocyclic compounds ,International Normalized Ratio ,cardiovascular diseases ,030212 general & internal medicine ,education ,Aged ,Point of care ,education.field_of_study ,Heartmate ii ,business.industry ,fungi ,Thrombosis ,General Medicine ,Middle Aged ,medicine.disease ,Multicenter study ,Ventricular assist device ,Cohort ,Cardiology ,Female ,Heart-Assist Devices ,business - Abstract
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.
- Published
- 2018
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