Home Management of Warfarin Treatment Through a Real-Time Supervised Telemedicine Solution: A Randomized Controlled Trial

Brasen, Claus Lohman; Madsen, Jonna Skov; Parkner, Tina; Brandslund, Ivan

doi:10.1089/tmj.2017.0260

Cited by 16 publications

(29 citation statements)

References 7 publications

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“…As a result, telemedicine has become an increasingly popular model for providing accurate international normalized ratio (INR) monitoring for patients taking warfarin. Other terms used to describe telemedicine include connected health [ 11 ], mobile health (mHealth) [ 12 ], and electronic health (eHealth) [ 13 ], which are collectively called technology-based interventions [ 14 ]. There is interest in learning whether these interventions can assist medication management and enhance patient compliance, with results suggesting some benefit [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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

Hengfen¹

2020

J Med Internet Res

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Background An increasing number of patients have received prophylactic or therapeutic oral anticoagulants (OACs) for thromboembolic complications of diseases. The use of OACs is associated with both clinical benefits and risks. Considering the challenges imposed by this class of drugs, as well as the enormous progress made in portable device technology, it is possible that technology-based interventions may improve clinical benefits for patients and optimize anticoagulation management. Objective This study was designed to comprehensively evaluate the role of technology-based interventions in the management of OACs. Methods We searched 6 databases—PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO—to retrieve relevant studies published as of November 1, 2019, to evaluate the effect of technology-based interventions on oral anticoagulation management. RevMan (version 5.3; Cochrane) software was used to evaluate and analyze clinical outcomes. The methodological quality of studies was assessed by the Cochrane risk of bias tool. Results A total of 15 randomized controlled trials (RCTs) were selected for analysis. They reported data for 2218 patients (1110 patients in the intervention groups and 1108 patients in the control groups). A meta-analysis was performed on the effectiveness and safety data reported in the RCTs. Technology-based interventions significantly improved the effectiveness of oral anticoagulation management (mean difference [MD]=6.07; 95% CI 0.84-11.30; I2=72%; P=.02). The safety of oral anticoagulation management was also improved, but the results were not statistically significant. Bleeding events were reduced (major bleeding events MD=1.02; 95% CI 0.78-1.32; I2=0%; P=.90; minor bleeding events MD=1.06, 95% CI 0.77-1.44; I2=41%; P=.73) and thromboembolism events were reduced (MD=0.71; 95% CI 0.49-1.01; I2=0%; P=.06). In general, patients were more satisfied with technology-based interventions, which could also improve their knowledge of anticoagulation management, improve their quality of life, and reduce mortality and hospitalization events. Conclusions Using technology to manage OACs can improve the effectiveness and safety of oral anticoagulation management, result in higher patient satisfaction, and allow greater understanding of anticoagulation.

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Section: Introductionmentioning

confidence: 99%

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

Hengfen¹

2020

J Med Internet Res

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“…A structured education program is required for patients and/ or caregivers and for involved professionals in health care and quality control. [146][147][148]…”

Section: In Controlling the Use Of Anticoagulantsmentioning

confidence: 99%

Guidelines os the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019

Lopes¹,

Oliveira²,

Ribeiro³

et al. 2019

Arquivos Brasileiros De Cardiologia

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“…The superiority of coagulation management by an INR measuring device such as the CoaguChek to laboratory measurements has been demonstrated several times in recent years. 9,[12][13][14] It has been proven that the CoaguChek device is safe for INR measurement, [15][16][17] and both methods had a high correlation coefficient (r ¼ 0.94, 95% confidence interval [CI]: 0.91-0.96; p < 0.01). 18 A study comparing 234 INR measurements by either the CoaguChek (median INR: 3.02) or laboratory testing (median INR: 3.07) found no differences between the methods.…”

Section: Discussionmentioning

confidence: 99%

Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device

Vogeler

Dieterlen

Garbade

et al. 2020

Thorac Cardiovasc Surg

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Background The exact monitoring of the therapeutic-range international normalized ratio (INR) after left ventricular assist device (LVAD) implantation is an important aim to reduce the risk of thrombosis or bleeding complications. Service providers offer a telemedical anticoagulation service (CS). Methods We compared LVAD patients using the CS (n = 15) to those who received regular medical care (RMC; n = 15) to investigate if telemedicine supervision increased the INR-specific time in the therapeutic range (TTR) during anticoagulation. All patients received self-management training for phenprocoumon medication according to their INR value. INR values were documented for 12 months. A survey (scale: 1 = not satisfied and 10 = very satisfied) was used to determine patient's satisfaction and psychological well-being. Results A total of 1,798 INR measurements were analyzed. The TTRRosendaal was higher in patients undergoing RMC (78.1 ± 14.3%) compared with that in patients using the CS (58.3 ± 28.0%, p = 0.03). The patient's satisfaction with the coagulation setting at the beginning of the study (RMC: 6.7 ± 3.1, CS: 7.2 ± 3.0, p = 0.74) and psychological wellbeing (RMC: 6.5 ± 1.9, CS: 6.5 ± 2.7, p = 0.97) were comparable between both groups. Conclusion We found that INR self-management is superior regarding the efficiency of post-LVAD anticoagulation therapy when compared with telemedical (CS)-based INR management in a small study cohort. Intensive training by experienced staff was able to replace CS.

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Home Management of Warfarin Treatment Through a Real-Time Supervised Telemedicine Solution: A Randomized Controlled Trial

Abstract: Using criteria to guide PSM interactions maintains good treatment effect while reducing healthcare expenses.

Cited by 16 publications

References 7 publications

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

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

Guidelines os the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019

Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device

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