Key result
Telephone-based service shows no benefit over usual care for warfarin time in therapeutic range.
Why the study?
Clinical outcomes of telephone-based service compared with usual clinic-based care for patients on warfarin needed systematic evaluation.
Does telephone-based service improve time in therapeutic range or reduce adverse events in patients on warfarin compared to usual clinic-based care?
Systematic Review (n=8,087)
Does telephone-based service improve time in therapeutic range or reduce adverse events in patients on warfarin compared to usual clinic-based care?
Telephone-based management of warfarin yields similar time in therapeutic range compared to usual clinic-based care, with potentially fewer adverse events.
Answers are grounded in this paper and cite their sources.
Telephone-based warfarin management yields similar TTR to usual care; supports remote services as viable alternatives for anticoagulation clinics.
Objective: To evaluate clinical outcomes of telephone-based service for patients on warfarin. Methods: Five bibliographic databases and gray literature were searched for articles that reported the effects of telephone interventions provided to patients using warfarin compared with those receiving usual clinic-based care. Mean difference (MD) and relative risk (RR) were used to calculate the effects of telephone intervention on time in therapeutic range (TTR) and visit in range (VIR), respectively. Adverse events (AEs) were pooled and reported as incidence rate ratios. Results: A total of 1,840 articles were examined. Eight articles involving 8,087 subjects were included in the quantitative synthesis. The pooled estimates from seven studies showed no difference on TTR between the telephone service group and the usual care group (MD 2.30; 95% confidence interval [CI] −3.56 to 8.16). In addition, VIR in the telephone service group was not different from the usual care group (RR 1.22, 95% CI 0.87–1.71). Moreover, patients in telephone service groups appeared to have a lower incidence of AEs compared with usual care groups. Discussion: Telephone-based service could be considered as an alternative anticoagulant management. However, owing to a lack of evidence from well-designed studies, further high-quality randomized control trials are warranted.
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Sakunrag et al. (2020) conducted a systematic review in Patients on warfarin (n=8,087). Telephone-based service vs. Usual clinic-based care was evaluated on Time in therapeutic range (TTR) (MD 2.30, 95% CI -3.56 to 8.16). Telephone-based service for patients on warfarin showed no significant difference in time in therapeutic range compared to usual care (MD 2.30; 95% CI -3.56 to 8.16).
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