Nurse Coordinator Driven Anticoagulation Protocol Can Be a Reliable Tool to Safely Manage Inrs in Lvad Patients

Introduction Achieving optimal anticoagulation remains a significant challenge in managing patients on left ventricular assist device (LVAD) support. Maintaining tight control of anticoagulation can be time consuming, and if not done appropriately, can lead to serious complications such as pump thrombosis and bleeding. We evaluated the efficacy and safety of a nurse coordinator driven outpatient protocol (NCDOP) on managing patient international normalized ratio (INR). Methods A pre-post analysis was completed on a quality improvement project from April 2019 to April 2020. In the first 6 months, INRs were collected by the nurse coordinator (NC) and sent to the nurse practitioner (NP) for review. The NP recommended a treatment plan to the NC who communicated it back to the patient. In the second 6-month period, the NC evaluated the INR and made changes specified on a protocol (Table 1). Major bleeding, thrombotic events (stroke and pump thrombosis), and overall hospitalizations were assessed. Time in therapeutic range (TTR) was used to assess anticoagulation target efficacy with the Rosendaal method. We surveyed our NP and NC to evaluate whether the NCDOP reduced INR management time and improved overall job satisfaction. Results Forty-seven patients (mean age 59.8 ± 12.1 years; 72% male), serving as their own control, met criteria to be included for analysis. There was no significant difference in TTR, mean LDH, or proportion of hospitalizations before and after the protocol was initiated (Table 2). Prior to the NCDOP, there were 6 major bleeding and 2 thrombotic events but none during the NCDOP period. The survey noted an approximate 50% reduction in time managing INRs for the NP and NC, as well as improved job satisfaction. Conclusions A NCDOP can be a reliable method to safely manage anticoagulation in LVAD patients. We hypothesize that this is the result of strict protocol adherence, faster turnaround time and greater autonomy of NC.