Telemedicine-Managed Anticoagulation Is Not Superior to Self-Management in LVAD Patients

Objectives: Telemedicine-guided anticoagulation monitoring of the therapeutic-range international normalized ratio (INR) is postulated to improve the efficiency and quality of anticoagulation therapy. We investigated if telemedicine supervision increased the INR-specific time in the therapeutic range (TTR) during anticoagulation in patients with left ventricular assist device (LVAD) implantation.

Methods: In a prospective, randomized study the INR values of LVAD patients with a telemedicine anticoagulation service (n = 15) were compared to INR values of LVAD patients with self-managed anticoagulation (n = 15) over a period of 12 months. TTRs, hospitalizations, comorbidities, thromboembolic and bleeding events as well as the costs for telemedicine service were documented. Patient’s satisfaction and psychological well-being were determined using a questionnaire (scale: 1 = very unsatisfied, 10 = very satisfied).

Results: The analysis of the 1,798 INR measurements revealed that the TTR as per Roosendaal was higher in patients with self-managed anticoagulation (78.1 ± 14.3%) than in patients with telemedicine anticoagulation service (58.3 ± 28.0%, p = 0.03). Postoperative adverse events such as bleeding or thromboembolic events did not differ significantly (p > 0.05) between the two groups. The patient’s satisfaction with the coagulation setting at the beginning of the study (self-managed: 6.7 ± 3.1, telemedicine: 7.2 ± 3.0, p = 0.74) and psychological well-being (self-managed: 6.5 ± 1.9, telemedicine: 6.5 ± 2.7, p = 0.97) were comparable between both groups. The costs amount to about 2,000 EUR per patient per month and included the telemedicine service and the device rental costs.

Conclusion: In our 1-year study, the higher TTR of patients with INR self-management compared to telemedicine service implies that anticoagulation management by a specialized, telemedicine-based service does not substantially improve the quality of anticoagulation therapy in LVAD patients. The additional telemedicine service did not show any advantage regarding the TTR or adverse events in our study cohort and caused high costs. Intensive training by experienced personnel should replace telemedicine anticoagulation service.