Key result
Telemedicine-based care for warfarin follow-up resulted in a significantly lower mean time in therapeutic range compared to in-person clinic visits (62.82% vs 70.61%, P=0.017).
Why the study?
Telemedicine is underutilized in Saudi Arabia despite evidence showing equivalence to office visits, prompting an analysis of telehealth-based care versus in-person visits for warfarin follow-up.
Does telemedicine-based care improve or maintain time in therapeutic range compared to in-person care in patients on warfarin?
Cohort (n=350)
No
Does telemedicine-based care improve or maintain time in therapeutic range compared to in-person care in patients on warfarin?
Absolute Event Rate: 62.82% vs 70.61%
p-value: p=0.017
Telemedicine-based warfarin follow-up was associated with a lower time in therapeutic range compared to in-person visits, suggesting it may be less effective for maintaining INR targets.
Telehealth linked to lower TTR than in-person warfarin care; leaves open whether refined protocols can match outcomes in prospective trials.
PURPOSE: Telemedicine is underutilized in Saudi Arabia, which is a matter of concern, especially since previous literature has showed its equivalence with office visits in providing access to care and convenience for patients while reducing anticoagulation-related bleeding events when appropriate measures are followed. The purpose of this study is to analyze the efficacy of telehealth-based care compared to in-person visit care for warfarin follow-up. METHODS: The authors conducted a retrospective chart review comparing the mean percentage of time in the therapeutic range (TTR) of international normalized ratio (INR) values among patients prescribed warfarin from July 2019 to November 2020 at King Faisal Specialist Hospital & Research Center - Jeddah Branch whose anticoagulant therapy was managed via telemedicine or through in-person clinic visits. A subcohort analysis of outcomes in the telemedicine and in-person groups was performed using propensity score matching, and descriptive analysis was done for the entire cohort. RESULTS: A total of 350 patient records were included in this retrospective study. Matched analysis for 148 patients using propensity score matching showed that the mean (SD) percentages of TTR were 62.82% (19.46%) and 70.61% (19.83%) in the telemedicine and in-person groups, respectively (P = 0.017). There was no statistical difference in the incidence of major or minor bleeding events, thromboembolic events, and hospital readmission between the two groups. CONCLUSION: The study results showed that patients on oral anticoagulation therapy managed through a telemedicine method had a lower overall TTR percentage than a matched group of patients managed through in-person anticoagulant clinic visits, thus demonstrating that using a telemedicine approach alone for warfarin follow-up may not help patients to maintain their INR target level.
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Alkhuzaee et al. (2023) conducted a cohort in oral anticoagulation therapy (n=350). Telemedicine-based medical care vs. In-person medical care was evaluated on mean percentage of time in the therapeutic range (TTR) of international normalized ratio (INR) values (p=0.017). Telemedicine-based care for warfarin follow-up resulted in a significantly lower mean time in therapeutic range compared to in-person clinic visits (62.82% vs 70.61%, P=0.017).
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