Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis

Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulatio...

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Published in:	Journal of medical Internet research Vol. 25; no. 1; p. e45922
Main Authors:	Braga Ferreira, Letícia, Lanna de Almeida, Rodrigo, Arantes, Alair, Abdulazeem, Hebatullah, Weerasekara, Ishanka, Ferreira, Leticia Santos Dias Norberto, Fonseca de Almeida Messias, Luana, Siuves Ferreira Couto, Luciana, Parreiras Martins, Maria Auxiliadora, Suelen Antunes, Núbia, Fonseca Cândido, Raissa Carolina, Rosa Ferreira, Samuel, Guerra Pezzini Assis, Tati, Marques Pedroso, Thais, Boersma, Eric, Ribeiro, Antonio, Marcolino, Milena Soriano
Format:	Journal Article
Language:	English
Published:	Canada Journal of Medical Internet Research 10-07-2023 Gunther Eysenbach MD MPH, Associate Professor JMIR Publications
Subjects:	Analysis Anticoagulants Anticoagulants (Medicine) Anticoagulants - therapeutic use Atrial fibrillation Bias Bleeding Cardiac arrhythmia Cardiovascular disease Care and treatment Cerebrovascular disease Chronic diseases Chronic illnesses Clinical decision making Clinical outcomes Clinical trials Cost analysis Decision support systems Extraction Heart Hemorrhage - chemically induced Hemorrhage - drug therapy High risk Humans Integrated care Internet Intervention Medical research Medicine, Experimental Meta-analysis Mortality Multimedia Quality of Life Review Risk factors Systematic review Telemedicine Thromboembolism Thromboembolism - chemically induced Thromboembolism - drug therapy Thromboembolism - prevention & control telemedicine atrial fibrillation DOACs eHealth anticoagulation warfarin
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Summary:	Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events. Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I =42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I =0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I =11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I =90%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life. PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208.
Bibliography:	SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Review-1 ObjectType-Article-3 ObjectType-Undefined-4
ISSN:	1438-8871 1439-4456 1438-8871
DOI:	10.2196/45922