Development of an Outpatient Guideline for Optimal Anticoagulation Bridging in Patients With Durable Mechanical Circulatory Support

Crit Pathw Cardiol. 2018 Mar;17(1):32-37. doi: 10.1097/HPC.0000000000000131.


Patients with durable mechanical circulatory support are at increased risk of thromboembolic and bleeding complications. Current guidelines recommend that these patients receive chronic anticoagulation with warfarin to maintain a target international normalized ratio (INR) as specified by device manufacturers. Limited data exist regarding management of subtherapeutic INRs in this setting. To standardize clinical practice at our institution, we assembled a multidisciplinary task force including members from various specialties to develop a guideline for managing subtherapeutic INRs that incorporates published data and expert opinion. In this article, we present our clinical practice guideline as a decision support tool to aid clinicians in developing a consistent strategy for managing subtherapeutic INRs and for safely bridging anticoagulation in patients receiving mechanical circulatory support.

MeSH terms

  • Ambulatory Care
  • Anticoagulants / therapeutic use*
  • Decision Support Systems, Clinical*
  • Heart-Assist Devices*
  • Hemorrhage / chemically induced
  • Humans
  • International Normalized Ratio
  • Practice Guidelines as Topic
  • Thromboembolism / prevention & control*
  • Warfarin / therapeutic use*


  • Anticoagulants
  • Warfarin