The effect of online versus hospital warfarin management on patient outcomes: a systematic review and meta-analysis
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Background Patients using oral anticoagulants are prone both to thrombus from insufficient anticoagulant therapy and to bleeding by overmedication, so there is a need for further exploring. Aim of the review To assess the effect of online management (using electronic communication such as smartphone), and hospital management on the outcome of patients on long-term anticoagulant therapy, and to explore an appropriate anticoagulation management model. Method Studies published in English prior to July 2017 were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library. Two researchers screened the literature independently, extracted the data and evaluated the methodological quality of the included studies. Meta-analysis was conducted using RevMan 5.3 software. The publication bias analysis was evaluated. Results A total of ten studies met the inclusion criteria, covering 16,915 patients. Of these, 8260 cases formed the online anticoagulation management group, and the other 8655 cases the hospital anticoagulant management group. There were no significant differences between the management models for time in therapeutic range, incidence of major or minor bleeding events, thromboembolic events, or warfarin-related emergency department visits. However, online management was associated with fewer warfarin-related hospital admissions than hospital management (odds ratio: 0.47, 95% confidence interval [0.30, 0.73]; P = 0.0009). Conclusion The online management of anticoagulant therapy was not inferior to hospital management, and may provide more convenient, higher quality anticoagulant therapy services for patients.
KeywordsAnticoagulation Hospital management Meta-Analysis Online management Systematic review
This research was funded by the Natural Science Foundation of Fujian Province of China [grant number 2018Y0037].
Conflicts of interest
The authors declare that they have no conflict of interest.
- 1.Zhang J, Liu M, Guan C, Tian H. Establishment and practice of online anticoagulation clinic. Chin Pharm J. 2014;49(16):1476–80.Google Scholar
- 2.Zang XZ, Liu DP. The significance and status of anticoagulation clinic. Chin J Cardiovasc Med. 2011;16(2):96.Google Scholar
- 17.Prochaska JH, Göbel S, Keller K, Coldewey M, Ullmann A, Lamparter H, Jünger C, Al-Bayati Z, Baer C, Walter U, Bickel C, ten Cate H, Münzel T, Wild PS. 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(1):14.CrossRefGoogle Scholar
- 18.Lee JC, Horner KE, Krummel ML, McDanel DL. Clinical and financial outcomes evaluation of multimodal pharmacist warfarin management of a statewide urban and rural population. J Pharm Pract. 2017;31(4):1–7.Google Scholar
- 22.Salvador CH, Ruiz-Sanchez A, González de Mingo MA, Carmona Rodríguez M, Carrasco MP, Sagredo PG, 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.CrossRefGoogle Scholar