Martinez Brandon K, Yik Brenda, Tran Raymond, Ilham Sabrina, Coleman Craig I, Jennings Douglas L, Baker William L
Hartford Hospital, Department of Pharmacy, Hartford, CT, USA.
University of Connecticut School of Pharmacy, Department of Pharmacy Practice, Storrs, CT, USA.
Artif Organs. 2018 Jul;42(7):700-704. doi: 10.1111/aor.13116. Epub 2018 Mar 6.
Continuous-flow left ventricular assist devices (CF-LVADs) prolong survival in advanced heart failure patients. Anticoagulation control is critical in CF-LVAD patients due to increased thromboembolic and bleeding risk. We assessed the quality of INR control in CF-LVAD patients measured by time in therapeutic range (TTR). We performed a systematic literature search of MEDLINE and SCOPUS through July 2017 to identify studies evaluating TTR in anticoagulated adult CF-LVAD patients. Data on key characteristics and the TTR end point were then extracted from each study by two investigators using a standardized tool. Using a Hartung-Knapp random effects model, a weighted mean TTR estimate with accompanying 95% confidence interval (CI) was calculated. Statistical heterogeneity was estimated using the I statistic. Five published studies were included. All studies were single-center, retrospective investigations that calculated TTR using the Rosendaal method. Sample sizes ranged from 11 to 115 patients (total of 270 patients) with durations of follow-up ranging from 9 to 76 person-years. On meta-analysis, CF-LVAD patients had a weighted mean TTR of 46.6% (95% CI: 36.0-57.3%, I = 94%). This suggests that warfarin is difficult to manage in CF-LVAD patients, which may contribute to high rates of bleeding and thromboembolic complications.
连续流左心室辅助装置（CF-LVADs）可延长晚期心力衰竭患者的生存期。由于血栓栓塞和出血风险增加，抗凝控制在CF-LVAD患者中至关重要。我们通过治疗范围内时间（TTR）评估了CF-LVAD患者的国际标准化比值（INR）控制质量。我们对截至2017年7月的MEDLINE和SCOPUS进行了系统的文献检索，以确定评估抗凝成年CF-LVAD患者TTR的研究。然后，两名研究人员使用标准化工具从每项研究中提取关键特征和TTR终点的数据。使用Hartung-Knapp随机效应模型，计算了加权平均TTR估计值及伴随的95%置信区间（CI）。使用I统计量估计统计异质性。纳入了五项已发表的研究。所有研究均为单中心回顾性研究，使用Rosendaal方法计算TTR。样本量从11例至115例患者不等（共270例患者），随访时间从9人年至76人年不等。荟萃分析显示，CF-LVAD患者的加权平均TTR为46.6%（95%CI：36.0 - 57.3%，I = 94%）。这表明华法林在CF-LVAD患者中难以管理，这可能导致出血和血栓栓塞并发症的发生率较高。
