Evaluation of Time in Therapeutic Range on Warfarin Therapy Between Face-to-Face and Telephone Follow-Up in a VA Medical Center

Blissit, Katie T.; Mullenix, Mackenzie L.; Brittain, Kevin

doi:10.1177/8755122514552497

Cited by 13 publications

(35 citation statements)

References 18 publications

(20 reference statements)

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“…However, the incidence of minor bleeding events was higher in the Alfalfa app group. This finding was similar to the results reported by Blissit et al, who concluded that the incidence of minor bleeding events was higher in the online anticoagulation management group [ 30 ]. The top three minor bleeding types in the offline group were nose bleeding (7 cases), gum bleeding (7 cases), and hematuria (4 cases).…”

Section: Discussionsupporting

confidence: 92%

“…The studies by Xia et al and Cryder et al showed that there were fewer anticoagulation-related hospital admissions in the online anticoagulation group [4,27]. Most studies have reported that there are no differences in the incidence of major bleeding events between the two groups [5,[27][28][29][30][31][32]. Our findings revealed that the incidences of thromboembolic events were similar between the two groups.…”

Section: Discussionsupporting

confidence: 64%

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Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Cao¹,

Jiang²,

Lv³

et al. 2021

JMIR Mhealth Uhealth

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Background Over the years, the internet has enabled considerable progress in the management of chronic diseases, especially hypertension and diabetes. It also provides novel opportunities in online anticoagulation management. Nevertheless, there is insufficient evidence regarding the effectiveness of online anticoagulation management. Objective This study explored the effectiveness and safety of warfarin management via the Alfalfa app, so as to provide evidence in support of anticoagulant management through online services. Methods In this retrospective, observational cohort study, 824 patients were included. In the offline group, patients went to the hospital clinic for warfarin management. In the Alfalfa app group, patients reported the dose of warfarin, current international normalized ratio (INR) value, and other related information through the Alfalfa app. Physicians or pharmacists used the app to adjust the dose of warfarin and determined the time for the next blood INR testing. Patients completed INR testing by point-of-care at home or hospital. The primary outcome of the study was the percentage of time in therapeutic range (TTR). Secondary outcomes included minor and major bleeding events, thrombotic events, warfarin-related emergency department visits, hospital admissions, and high INR values. Results The TTR and percentage of INR values in the range were significantly higher in the Alfalfa app group than in the offline group (79.35% vs 52.38%, P<.001; 3314/4282, 77.39% vs 2005/4202, 47.72%, P<.001, respectively). Patients managed via the Alfalfa app had lower rates of subtherapeutic (172/4282, 4.02% vs 388/4202, 9.23%; P<.001), supratherapeutic (487/4282, 11.37% vs 882/4202, 20.99%; P<.001), and extreme subtherapeutic INR values (290/4282, 6.77% vs 910/4202, 21.66%; P<.001). Additionally, the Alfalfa app group had lower incidences of major bleeding (2/425, 0.5% vs 12/399, 3.0%; P=.005), warfarin-related emergency department visits (13/425, 3.1% vs 37/399, 9.3%; P<.001), and hospital admissions (1/425, 0.2% vs 12/399, 3.0%; P=.001) compared with the offline group. However, the Alfalfa app group had a higher incidence of minor bleeding than the offline group (45/425, 10.6% vs 20/399, 5.0%; P=.003). There were similar incidences in extreme supratherapeutic INR values (19/4282, 0.44% vs 17/4202, 0.40%; P=.78) and thromboembolic events (1/425, 0.2% vs 1/399, 0.3%; P=.53) between the two groups. Conclusions Warfarin management is superior via the Alfalfa app than via offline services in terms of major bleeding events, warfarin-related emergency department visits, and hospital admissions.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 64%

Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Cao¹,

Jiang²,

Lv³

et al. 2021

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

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“…With warfarin, the disadvantages are as follows: wide array of pharmacokinetic variability, the multiple drug-drug interactions, and the need for restrictions on diet and alcohol consumption, and consequently the need for frequent blood monitoring of INR, a normalized ratio of prothrombin time, which measures the narrow therapeutic window of warfarin's efficacy. It has been found that warfarin stays within the therapeutic range rarely above 65% of the duration of the therapy [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Reversal Strategies for Intracranial Hemorrhage Related to Direct Oral Anticoagulant Medications

Dabi

Koutrouvelis²

2018

Critical Care Research and Practice

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Direct oral anticoagulants (DOACs) are a new class of anticoagulants that directly inhibit either thrombin or factor Xa in the coagulation cascade. They are being increasingly used instead of warfarin or other vitamin K antagonists (VKAs). Adverse side effects of DOACs may result in hemorrhagic complications, including life-threatening intracranial hemorrhage (ICH), though to a much lesser degree than VKAs. Currently there are relatively limited indications for DOACS but their usage is certain to expand with the availability of their respective specific reversal agents. Currently, only idarucizumab (antidote for dabigatran) has been United States Food and Drug Administration- (FDA-) approved, but others (andexanet-α and ciraparantag) may be approved in near future, and the development and availability of such reversal agents have the potential to dramatically change the current anticoagulant use by providing reversal of multiple oral anticoagulants. Until all the DOACs have FDA-approved reversal agents, the treatment of the dreaded side effects of bleeding is challenging. This article is an attempt to provide an overview of the management of hemorrhage, especially ICH, related to DOAC use.

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“…The sample size ranged from 1 [74] to 217,014 [62], with a median of 157 and a mean of 7977 participants per study. Overall, 21 studies enrolled ≥100 participants [51,[53][54][55][56][57][58][59][60]62,63,[65][66][67][68][69][70]72,73,76,80] and 11 had <100 participants [42,52,61,64,71,74,75,[77][78][79]81].…”

Section: Description Of the Included Studiesmentioning

confidence: 99%

“…Of the 32 included studies, 12 (34%) studied malignant hematological conditions [42,53,[58][59][60][61]64,67,69,77,80,81], 18 (59%) studied nonmalignant conditions with percentages [51,52,[54][55][56][57]62,63,65,66,68,[70][71][72][73][74]76,78], and 2 (6%) studied both malignant and nonmalignant conditions [75,79]. [68,79], 1 (3%) was a case study [74], 1 (3%) was a pre-post study [54], 1 (3%) was a noncomparative prospective study [59], and 1 (3%) was a prospective cohort study [66].…”

Section: Description Of the Included Studiesmentioning

confidence: 99%

Telemedicine in Malignant and Nonmalignant Hematology: Systematic Review of Pediatric and Adult Studies

Shah

O’Dwyer

Badawy

2021

JMIR Mhealth Uhealth

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Background Telemedicine, including video-, web-, and telephone-based interventions, is used in adult and pediatric populations to deliver health care and communicate with patients. In the realm of hematology, telemedicine has recently been used to safely and efficiently monitor treatment side-effects, perform consultations, and broaden the reach of subspecialty care. Objective We aimed to synthesize and analyze information regarding the feasibility, acceptability, and potential benefits of telemedicine interventions in malignant and nonmalignant hematology, as well as assess the recognized limitations of these interventions. Methods Studies were identified through a comprehensive Medical Subject Headings (MeSH) search on the PubMed MEDLINE, Controlled Register of Clinical Trials (Cochrane CENTRAL from Wiley), Embase, and CINAHL (EBSCO) databases on February 7, 2018. A second search, utilizing the same search strategy, was performed on October 1, 2020. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the reporting of included evidence. Included studies were original articles researching the feasibility, acceptability, and clinical outcomes of telemedicine or telehealth interventions in pediatric or adult populations with malignant or nonmalignant hematological conditions. Data items in the extraction form included first author name, publication year, country, malignant or nonmalignant hematological condition or disease focus of the study, participant age, participant age subgroup (pediatric or adult), study design and setting, telemedicine intervention type and description, study purpose, and main study outcomes. Results A total of 32 articles met the preset criteria and were included in this study. Most (25/32) studies were conducted in adults, and the remaining (7/32) were conducted in the pediatric population. Of the 32 studies, 12 studied malignant hematological conditions, 18 studied nonmalignant conditions, and two studied both malignant and nonmalignant conditions. Study types included pilot study (11/32), retrospective study (9/32), randomized controlled trial (6/32), cross-sectional study (2/32), case study (1/32), pre-post study (1/32), noncomparative prospective study (1/32), and prospective cohort study (1/32). The three main types of telemedicine interventions utilized across all studies were video-based (9/32), telephone-based (9/32), and web-based interventions (14/32). Study results showed comparable outcomes between telemedicine and traditional patient encounter groups across both pediatric and adult populations for malignant and nonmalignant hematological conditions. Conclusions Evidence from this review suggests that telemedicine use in nonmalignant and malignant hematology provides similar or improved health care compared to face-to-face encounters in both pediatric and adult populations. Telemedicine interventions utilized in the included studies were well received in both pediatric and adult settings. However, more research is needed to determine the efficacy of implementing more widespread use of telemedicine for hematological conditions.

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Evaluation of Time in Therapeutic Range on Warfarin Therapy Between Face-to-Face and Telephone Follow-Up in a VA Medical Center

Cited by 13 publications

References 18 publications

Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study

Reversal Strategies for Intracranial Hemorrhage Related to Direct Oral Anticoagulant Medications

Telemedicine in Malignant and Nonmalignant Hematology: Systematic Review of Pediatric and Adult Studies

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