Do telehealth interventions improve oral anticoagulation management? A systematic review and meta-analysis

Abstract

The benefits and harms of telehealth interventions compared to usual care for oral anticoagulation management are unclear. A systematic review and meta-analysis was conducted to assess their impact on clinically important outcomes. A search was conducted through MEDLINE, EMBASE and CENTRAL databases, and the retrieved citations were independently screened and extracted by two review authors. Cochrane Collaboration-recommended tools were used to assess for risk of bias. Co-primary outcomes were major bleeding and major thromboembolic events. Of 2145 retrieved citations, 7 were included for qualitative synthesis (1 randomized controlled trial, 1 prospective cohort and 5 retrospective cohorts). None addressed direct oral anticoagulants. Telehealth interventions were mainly consisted of telephone visits by clinicians, pharmacists and specialists. Meta-analysis of 3 studies (n = 6955) showed significant improvements in the telehealth group for major thromboembolic events (RR 0.43, 95% CI 0.25-0.74, p = 0.002), but no significant difference for major bleeding events (RR 0.83, 95% CI 0.52-1.33, p = 0.44). There was no significant difference in any of the secondary outcomes. The overall GRADE quality of evidence was rated very low due to high risk of bias and low precision. Based on very low quality evidence, telehealth interventions may lower the risk of major thromboembolic events, but not other clinically important outcomes. A high quality study is likely to strongly influence these results. High quality randomized trials are recommended to better assess the benefits and harms of telehealth interventions for anticoagulation management.

Technology-Based Interventions in Oral Anticoagulation Management: Meta-Analysis of Randomized Controlled Trials

“…Although the study of telemedicine is not specific to OACs and is primarily qualitative, previous studies have highlighted similar challenges [ 42 - 44 ]. Clinical pharmaceutical care provided by Niznik et al [ 43 ] through telemedicine (mainly by telephone) in inpatient or outpatient settings was found to have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence to the management of various chronic diseases.…”

“…Considering the convenience and economy of technology-based interventions, online anticoagulation management is more suitable for patients with stable conditions and for whom transportation may be difficult, such as those with disabilities or who live far from the hospital. Lee et al’s study [ 42 ] suggested that most outcomes for telemedicine were similar to those for conventional medical care, but the incidence of major thromboembolism events was significantly lower in the telemedicine group. However, the papers they included had a higher risk of bias and were of a lower quality study design, and the level of evidence supporting this conclusion was very low.…”

Optimising health outcomes via pharmacist delivered telehealth medicines management: a systematic review

“…These findings are consistent with a previous meta-analysis that found telehealth interventions generally improved oral anticoagulation management. 38 While this surrogate outcome was significantly improved in the telehealth group, it appears that clinically relevant outcomes (e.g. bleeds, thrombotic events) remained equivalent between the two groups, both in this current systematic review and a previous systematic review on generalised telehealth interventions.…”

“…bleeds, thrombotic events) remained equivalent between the two groups, both in this current systematic review and a previous systematic review on generalised telehealth interventions. 38 It was noted that studies with a longer follow up duration were more likely to result in clinically significant outcomes when compared to shorter follow up periods. The possible explanations for these findings may include pharmacists having a greater time period to build rapport, or that longer follow up resulted in a greater number of interventions.…”

Telemedicina aplicada a COVID-19

“…Las teleconsultas parece que inducen a una mayor frecuencia de contacto entre médico y paciente, pero de menor duración 4,5 . Además, la telemedicina ha demostrado reducir la tasa de hospitalización cuando se aplica a consultas de anticoagulación 6 o a malnutrición en pacientes ancianos 7 .…”