The influence of internet-based telemedicine on warfarin management: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DAI Hengfen ¹ ,  ZHENG Caiyun ² , ZHENG Qiaowen ³ , XUE Yan ² , CHEN Xu ² , LIU Yunchun ¹ , ZHANG Hong ¹

1. Department of Pharmacy, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, 350009, P.R.China;
2. Department of Clinical Pharmacy, Fuqing City Hospital, Fuzhou, 350300, P.R.China;
3. Department of Cardiology, Fuqing City Hospital, Fuzhou, 350300, P.R.China;

Corresponding?author：

ZHENG Caiyun, Email: saiun1992@163.com

Keywords：

Telemedicine; oral anticoagulation management; warfarin; systematic review; meta-analysis

DOI：

10.7507/1007-4848.202004003

Video：

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Objective To systematically evaluate the effects of telemedicine on the management of warfarin therapy.Methods We searched PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang Database (from inception to February 2020) and conducted retrospective literature searching to identify studies about the management of warfarin using telemedicine intervention techniques. R language software was used to evaluate the efficacy and safety of telemedicine on warfarin management.Results A total of 7 239 articles were retrieved, and 12 articles were finally included according to inclusion and exclusion criteria, totaling 8 112 patients, including 3 726 patients in the intervention group and 4 386 patients in the control group. The results of meta-analysis showed that there was a statistical difference in the accurate international normalized ratio (INR) treatment target range time ratio between the intervention group and the control group (MD=6.52, 95%CI 2.13 to 10.92, P<0.01, I²=89%). The incidence of bleeding events (RR=0.61, 95%CI 0.46 to 0.81, P=0.97, I²=0%) and the incidence of thromboembolic events (RR=0.50, 95%CI 0.29 to 0.85, P=0.63, I²=0%) were not statistically different between the two groups. Conclusion Existing evidence indicates that telemedicine management has a benefit in anticoagulant efficacy compared with conventional anticoagulant management in patients with thrombotic diseases, but there is no statistical difference in safety. Limited by the quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.

Citation： DAI Hengfen, ZHENG Caiyun, ZHENG Qiaowen, XUE Yan, CHEN Xu, LIU Yunchun, ZHANG Hong. The influence of internet-based telemedicine on warfarin management: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1454-1459. doi: 10.7507/1007-4848.202004003 Copy

1.	《中國血栓性疾病防治指南》專家委員會. 中國血栓性疾病防治指南. 中華醫學雜志, 2018, 98(36): 2861-2888.
2.	Ogilvie IM, Newton N, Welner SA, et al. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med, 2010, 123(7): 638-645.
3.	Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J, 2018, 39(16): 1330-93.
4.	Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med, 2012, 157(11): 785-795.
5.	黃娜, 陳蜀惠, 周英鳳, 等. 遠程醫療改善妊娠期糖尿病患者血糖和妊娠結局有效性和安全性的系統評價. 中國循證醫學雜志, 2019, 19(8): 960-967.
6.	Deeken F, Rezo A, Hinz M, et al. Evaluation of technology-based interventions for informal caregivers of patients with dementia-A meta-analysis of randomized controlled trials. Am J Geriatr Psychiatry, 2019, 27(4): 426-445.
7.	Ryan F, Byrne S, O'Shea S. Randomized controlled trial of supervised patient self-testing of warfarin therapy using an Internet-based expert system. J Thromb Haemost, 2009, 7(8): 1284-1290.
8.	Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
9.	Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol, 2013, 66(9): 982-993.
10.	Fitzmaurice DA, Murray ET, Gee KM, et al. A randomised controlled trial of patient self-management of oral anticoagulation treatment compared with primary care management. J Clin Pathol, 2002, 55(11): 845-849.
11.	Soliman Hamad MA, van Eekelen E, van Agt T, et al. Self-management program improves anticoagulation control and quality of life: a prospective randomized study. Eur J Cardiothorac Surg, 2009, 35(2): 265-269.
12.	Brasen CL, Madsen JS, Parkner T, et al. Home management of warfarin treatment through a real-time supervised telemedicine solution: a randomized controlled trial. Telemed J E Health, 2019, 25(2): 109-115.
13.	顧敏. 遠程醫療應用于心房顫動華法林抗凝管理的研究[碩士]: 揚州大學, 2019.
14.	Ferrando F, Mira Y. Effective and safe management of oral anticoagulation therapy in patients who use the Internet-accessed telecontrol tool sintromacweb. Interact J Med Res, 2015, 4(2): e10.
15.	薛盛龍, 薛盛東, 陳紹奉, 等. 移動醫療技術在抗凝門診中的應用效果觀察. 中醫藥管理雜志, 2018, 26(7): 32-35.
16.	Prochaska JH, G?bel S, Keller K, et al. E-health-based management of patients receiving oral anticoagulation therapy: results from the observational thrombEVAL study. J Thromb Haemost, 2017, 15(7): 1375-1385.
17.	Prochaska JH, G?bel S, Keller K, et al. Quality of oral anticoagulation with phenprocoumon in regular medical care and its potential for improvement in a telemedicine-based coagulation service--results from the prospective, multi-center, observational cohort study thrombEVAL. BMC Med, 2015, 13: 14.
18.	Cao H, Wu J, Zhang J. Outcomes of warfarin therapy managed by pharmacists via hospital anticoagulation clinic versus online anticoagulation clinic. Int J Clin Pharm, 2018, 40(5): 1072-1077.
19.	Hawkins KL, King J, Delate T, et al. Pharmacy technician management of stable, in-range INRS within a clinical pharmacy anticoagulation service. J Manag Care Spec Pharm, 2018, 24(11): 1130-1137.
20.	李金澤, 董一君, 錢永軍, 等. 心臟機械瓣膜置換術后抗凝治療遠程管理:前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2019, 26(4): 49-53.
21.	Salvador CH, Ruiz-Sanchez A, González de Mingo MA, et al. Evaluation of a telemedicine-based service for the follow-up and monitoring of patients treated with oral anticoagulant therapy. IEEE Trans Inf Technol Biomed, 2008, 12(6): 696-706.
22.	鄭月宏, 章旭. 靜脈血栓栓塞性疾病的合理抗凝治療. 臨床誤診誤治, 2018, 275(7): 7-10.
23.	Hou K, Yang H, Ye Z, et al. Effectiveness of pharmacist-led anticoagulation management on clinical outcomes: a systematic review and meta-analysis. J Pharm Pharm Sci, 2017, 20(1): 378-396.
24.	Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet, 2006, 367(9508): 404-411.
25.	Samsa GP, Matchar DB. Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management. J Thromb Thrombolysis, 2000, 9(3): 283-292.
26.	Herijgers P, Verhamme P. Improving the quality of anticoagulant therapy in patients with mechanical heart valves: what are we waiting for? Eur Heart J, 2007, 28(20): 2424-2426.

1. 《中國血栓性疾病防治指南》專家委員會. 中國血栓性疾病防治指南. 中華醫學雜志, 2018, 98(36): 2861-2888.
2. Ogilvie IM, Newton N, Welner SA, et al. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med, 2010, 123(7): 638-645.
3. Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J, 2018, 39(16): 1330-93.
4. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med, 2012, 157(11): 785-795.
5. 黃娜, 陳蜀惠, 周英鳳, 等. 遠程醫療改善妊娠期糖尿病患者血糖和妊娠結局有效性和安全性的系統評價. 中國循證醫學雜志, 2019, 19(8): 960-967.
6. Deeken F, Rezo A, Hinz M, et al. Evaluation of technology-based interventions for informal caregivers of patients with dementia-A meta-analysis of randomized controlled trials. Am J Geriatr Psychiatry, 2019, 27(4): 426-445.
7. Ryan F, Byrne S, O'Shea S. Randomized controlled trial of supervised patient self-testing of warfarin therapy using an Internet-based expert system. J Thromb Haemost, 2009, 7(8): 1284-1290.
8. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
9. Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol, 2013, 66(9): 982-993.
10. Fitzmaurice DA, Murray ET, Gee KM, et al. A randomised controlled trial of patient self-management of oral anticoagulation treatment compared with primary care management. J Clin Pathol, 2002, 55(11): 845-849.
11. Soliman Hamad MA, van Eekelen E, van Agt T, et al. Self-management program improves anticoagulation control and quality of life: a prospective randomized study. Eur J Cardiothorac Surg, 2009, 35(2): 265-269.
12. Brasen CL, Madsen JS, Parkner T, et al. Home management of warfarin treatment through a real-time supervised telemedicine solution: a randomized controlled trial. Telemed J E Health, 2019, 25(2): 109-115.
13. 顧敏. 遠程醫療應用于心房顫動華法林抗凝管理的研究[碩士]: 揚州大學, 2019.
14. Ferrando F, Mira Y. Effective and safe management of oral anticoagulation therapy in patients who use the Internet-accessed telecontrol tool sintromacweb. Interact J Med Res, 2015, 4(2): e10.
15. 薛盛龍, 薛盛東, 陳紹奉, 等. 移動醫療技術在抗凝門診中的應用效果觀察. 中醫藥管理雜志, 2018, 26(7): 32-35.
16. Prochaska JH, G?bel S, Keller K, et al. E-health-based management of patients receiving oral anticoagulation therapy: results from the observational thrombEVAL study. J Thromb Haemost, 2017, 15(7): 1375-1385.
17. Prochaska JH, G?bel S, Keller K, et al. Quality of oral anticoagulation with phenprocoumon in regular medical care and its potential for improvement in a telemedicine-based coagulation service--results from the prospective, multi-center, observational cohort study thrombEVAL. BMC Med, 2015, 13: 14.
18. Cao H, Wu J, Zhang J. Outcomes of warfarin therapy managed by pharmacists via hospital anticoagulation clinic versus online anticoagulation clinic. Int J Clin Pharm, 2018, 40(5): 1072-1077.
19. Hawkins KL, King J, Delate T, et al. Pharmacy technician management of stable, in-range INRS within a clinical pharmacy anticoagulation service. J Manag Care Spec Pharm, 2018, 24(11): 1130-1137.
20. 李金澤, 董一君, 錢永軍, 等. 心臟機械瓣膜置換術后抗凝治療遠程管理:前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2019, 26(4): 49-53.
21. Salvador CH, Ruiz-Sanchez A, González de Mingo MA, et al. Evaluation of a telemedicine-based service for the follow-up and monitoring of patients treated with oral anticoagulant therapy. IEEE Trans Inf Technol Biomed, 2008, 12(6): 696-706.
22. 鄭月宏, 章旭. 靜脈血栓栓塞性疾病的合理抗凝治療. 臨床誤診誤治, 2018, 275(7): 7-10.
23. Hou K, Yang H, Ye Z, et al. Effectiveness of pharmacist-led anticoagulation management on clinical outcomes: a systematic review and meta-analysis. J Pharm Pharm Sci, 2017, 20(1): 378-396.
24. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet, 2006, 367(9508): 404-411.
25. Samsa GP, Matchar DB. Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management. J Thromb Thrombolysis, 2000, 9(3): 283-292.
26. Herijgers P, Verhamme P. Improving the quality of anticoagulant therapy in patients with mechanical heart valves: what are we waiting for? Eur Heart J, 2007, 28(20): 2424-2426.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The influence of internet-based telemedicine on warfarin management: A systematic review and meta-analysis

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