Technology-Based Interventions in Oral Anticoagulation Management: Meta-Analysis of Randomized Controlled Trials

Hengfen Dai; Caiyun Zheng; Chun Lin; Yan Zhang; Hong Zhang; Fan Chen; Yunchun Liu; Jingwen Xiao; Chaoxin Chen

doi:10.2196/18386

May 14, 2020Journal of Medical Internet ResearchOpen Access

Technology-Based Interventions in Oral Anticoagulation Management: Meta-Analysis of Randomized Controlled Trials

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Why the study?

Given the challenges and risks of oral anticoagulants alongside advances in portable device technology, technology-based interventions may optimize anticoagulation management and clinical benefits.

Do technology-based interventions improve the effectiveness and safety of oral anticoagulation management compared to traditional management?

Structured PICO

Do technology-based interventions improve the effectiveness and safety of oral anticoagulation management compared to traditional management?

P

Population

2,218 patients receiving prophylactic or therapeutic oral anticoagulants (OACs) across 15 randomized controlled trials

I

Intervention

Technology-based interventions for oral anticoagulation management (including telephone, internet, voicemail messaging, and telemedicine software)

C

Comparator

Traditional oral anticoagulation management

O

Outcome

Effectiveness (Time within target INR range [TTR]) and safety (bleeding and thromboembolism events)surrogate

Technology-based interventions for oral anticoagulation management significantly improve time in therapeutic range and patient satisfaction without increasing bleeding or thromboembolic risks.

Limitations

Relatively small sample sizes in included studies
Varying follow-up times, with some as short as 1 month
Potential lack of patient adherence to technology-based interventions

Implication

Technology-based interventions improve OAC effectiveness; extends RCT evidence for digital tools in routine anticoagulation management.

Abstract

Background An increasing number of patients have received prophylactic or therapeutic oral anticoagulants (OACs) for thromboembolic complications of diseases. The use of OACs is associated with both clinical benefits and risks. Considering the challenges imposed by this class of drugs, as well as the enormous progress made in portable device technology, it is possible that technology-based interventions may improve clinical benefits for patients and optimize anticoagulation management. Objective This study was designed to comprehensively evaluate the role of technology-based interventions in the management of OACs. Methods We searched 6 databases—PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO—to retrieve relevant studies published as of November 1, 2019, to evaluate the effect of technology-based interventions on oral anticoagulation management. RevMan (version 5.3; Cochrane) software was used to evaluate and analyze clinical outcomes. The methodological quality of studies was assessed by the Cochrane risk of bias tool. Results A total of 15 randomized controlled trials (RCTs) were selected for analysis. They reported data for 2218 patients (1110 patients in the intervention groups and 1108 patients in the control groups). A meta-analysis was performed on the effectiveness and safety data reported in the RCTs. Technology-based interventions significantly improved the effectiveness of oral anticoagulation management (mean difference [MD]=6.07; 95% CI 0.84-11.30; I2=72%; P=.02). The safety of oral anticoagulation management was also improved, but the results were not statistically significant. Bleeding events were reduced (major bleeding events MD=1.02; 95% CI 0.78-1.32; I2=0%; P=.90; minor bleeding events MD=1.06, 95% CI 0.77-1.44; I2=41%; P=.73) and thromboembolism events were reduced (MD=0.71; 95% CI 0.49-1.01; I2=0%; P=.06). In general, patients were more satisfied with technology-based interventions, which could also improve their knowledge of anticoagulation management, improve their quality of life, and reduce mortality and hospitalization events. Conclusions Using technology to manage OACs can improve the effectiveness and safety of oral anticoagulation management, result in higher patient satisfaction, and allow greater understanding of anticoagulation.