Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis
BackgroundOral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. ObjectiveThe aim of the study is to systematically review the evidence...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-07-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2023/1/e45922 |
| _version_ | 1797734068898496512 |
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| author | Letícia Braga Ferreira Rodrigo Lanna de Almeida Alair Arantes Hebatullah Abdulazeem Ishanka Weerasekara Leticia Santos Dias Norberto Ferreira Luana Fonseca de Almeida Messias Luciana Siuves Ferreira Couto Maria Auxiliadora Parreiras Martins Núbia Suelen Antunes Raissa Carolina Fonseca Cândido Samuel Rosa Ferreira Tati Guerra Pezzini Assis Thais Marques Pedroso Eric Boersma Antonio Ribeiro Milena Soriano Marcolino |
| author_facet | Letícia Braga Ferreira Rodrigo Lanna de Almeida Alair Arantes Hebatullah Abdulazeem Ishanka Weerasekara Leticia Santos Dias Norberto Ferreira Luana Fonseca de Almeida Messias Luciana Siuves Ferreira Couto Maria Auxiliadora Parreiras Martins Núbia Suelen Antunes Raissa Carolina Fonseca Cândido Samuel Rosa Ferreira Tati Guerra Pezzini Assis Thais Marques Pedroso Eric Boersma Antonio Ribeiro Milena Soriano Marcolino |
| author_sort | Letícia Braga Ferreira |
| collection | DOAJ |
| description |
BackgroundOral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it.
ObjectiveThe 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.
MethodsRandomized 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.
ResultsIn 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; I2=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=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).
ConclusionsTelemedicine-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.
Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208 |
| first_indexed | 2024-03-12T12:38:54Z |
| format | Article |
| id | doaj.art-f6b2eb61062b4e51b6f5509268fca456 |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:38:54Z |
| publishDate | 2023-07-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-f6b2eb61062b4e51b6f5509268fca4562023-08-29T00:02:44ZengJMIR PublicationsJournal of Medical Internet Research1438-88712023-07-0125e4592210.2196/45922Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysisLetícia Braga Ferreirahttps://orcid.org/0000-0002-4370-8530Rodrigo Lanna de Almeidahttps://orcid.org/0000-0002-8988-6578Alair Aranteshttps://orcid.org/0000-0001-6515-7437Hebatullah Abdulazeemhttps://orcid.org/0000-0002-4529-7114Ishanka Weerasekarahttps://orcid.org/0000-0002-8195-5057Leticia Santos Dias Norberto Ferreirahttps://orcid.org/0009-0002-0570-136XLuana Fonseca de Almeida Messiashttps://orcid.org/0000-0001-6934-298XLuciana Siuves Ferreira Coutohttps://orcid.org/0000-0002-7948-222XMaria Auxiliadora Parreiras Martinshttps://orcid.org/0000-0002-5211-411XNúbia Suelen Antuneshttps://orcid.org/0000-0001-9166-7588Raissa Carolina Fonseca Cândidohttps://orcid.org/0000-0002-5353-8125Samuel Rosa Ferreirahttps://orcid.org/0000-0001-7051-4072Tati Guerra Pezzini Assishttps://orcid.org/0000-0001-7650-318XThais Marques Pedrosohttps://orcid.org/0000-0003-0149-9731Eric Boersmahttps://orcid.org/0000-0002-2559-7128Antonio Ribeirohttps://orcid.org/0000-0002-2740-0042Milena Soriano Marcolinohttps://orcid.org/0000-0003-4278-3771 BackgroundOral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. ObjectiveThe 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. MethodsRandomized 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. ResultsIn 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; I2=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=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). ConclusionsTelemedicine-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. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208https://www.jmir.org/2023/1/e45922 |
| spellingShingle | Letícia Braga Ferreira Rodrigo Lanna de Almeida Alair Arantes Hebatullah Abdulazeem Ishanka Weerasekara Leticia Santos Dias Norberto Ferreira Luana Fonseca de Almeida Messias Luciana Siuves Ferreira Couto Maria Auxiliadora Parreiras Martins Núbia Suelen Antunes Raissa Carolina Fonseca Cândido Samuel Rosa Ferreira Tati Guerra Pezzini Assis Thais Marques Pedroso Eric Boersma Antonio Ribeiro Milena Soriano Marcolino Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis Journal of Medical Internet Research |
| title | Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis |
| title_full | Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis |
| title_fullStr | Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis |
| title_full_unstemmed | Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis |
| title_short | Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis |
| title_sort | telemedicine based management of oral anticoagulation therapy systematic review and meta analysis |
| url | https://www.jmir.org/2023/1/e45922 |
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