Implementation of pharmacist‐managed anticoagulation in patients with continuous flow left ventricular assist devices

Background Patients with left ventricular assist devices (LVADs) are at high risk for bleeding and thrombotic events and may benefit from intensified anticoagulation management via a pharmacist‐managed anticoagulation service. Aims The aim of this quality improvement project was to implement and assess anticoagulation management by a pharmacist‐managed warfarin anticoagulation service in LVAD patients. Materials and Methods This was a pilot study to assess the outcomes of anticoagulation management by a pharmacist‐managed outpatient anticoagulation service for the first 3 months following hospital discharge of patients with a newly implanted LVAD compared with a historical control group of LVAD patients managed by the previous standard‐of‐care. Time in therapeutic range and percent of international normalized ratio (INR) values within range were assessed as measures of anticoagulation. Twenty‐six patients were in the intervention group and an equal number of controls were included for analysis. Results Patients in the pharmacist‐managed intervention group experienced a significantly greater INR time in therapeutic range than the control group (66% vs 46.9%; P = 0.003) and a greater percentage of INRs within therapeutic range (62.6% vs 43.8%; P = 0.002). Discussion and Conclusion Pharmacist‐managed anticoagulation was associated with improved INR control in this pilot group of LVAD patients in the first 3 months posthospital discharge. Additional study is warranted to determine if this benefit continues beyond 3 months, and to further assess clinical outcomes of thrombosis and bleeding events between groups.