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March 6, 2018Artificial Organs

Meta‐Analysis of Time in Therapeutic Range in Continuous‐Flow Left Ventricular Assist Device Patients Receiving Warfarin

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Why the study?

What is the quality of INR control measured by time in therapeutic range (TTR) in adult CF-LVAD patients receiving warfarin?

Population

5 retrospective single-center studies pooling 270 adult patients with continuous-flow left ventricular…

Design

Meta-analysis

Follow-up

9 to 76 person-years

Key result

Warfarin therapy in patients with continuous-flow left ventricular assist devices resulted in a weighted mean time in therapeutic range of 46.6% (95% CI 36.0-57.3%).

Authors

BMBrandon MartinezBYBrenda YikRTRaymond Tran

Discussion

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Member takes

Overview

Suboptimal TTR (~47%) in CF-LVAD patients signals elevated thromboembolic/bleeding risk; leaves open optimal anticoagulation strategies pending prospective trials.

Study Design

Type

Meta-Analysis (n=270)

Structured PICO

What is the quality of INR control measured by time in therapeutic range (TTR) in adult CF-LVAD patients receiving warfarin?

P
Population
270 adult patients with continuous-flow left ventricular assist devices receiving warfarin, pooled from 5 retrospective studies with 9 to 76 person-years of follow-up.
E
Exposure
Warfarin
O
Outcome
Time in therapeutic range (TTR) calculated using the Rosendaal methodsurrogate

CF-LVAD patients receiving warfarin have a low mean time in therapeutic range (46.6%), highlighting the difficulty of anticoagulation management in this population.

Limitations

  • All included studies were single-center, retrospective investigations
  • High statistical heterogeneity (I2 = 94%)
  • High statistical heterogeneity (I² = 94%)

Cite This Study

Martinez et al. (2018) conducted a meta-analysis in Advanced heart failure with continuous-flow left ventricular assist devices (CF-LVADs) (n=270). Warfarin was evaluated on Time in therapeutic range (TTR) (95% CI 36.0-57.3). Warfarin therapy in patients with continuous-flow left ventricular assist devices resulted in a weighted mean time in therapeutic range of 46.6% (95% CI 36.0-57.3%).

synapsesocial.com/papers/6a5e4acace909d4c3f67f0a6https://doi.org/10.1111/aor.13116
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