Therapeutics and Clinical Risk Management (Mar 2023)

The Value of Anticoagulation Management Combining Telemedicine and Self-Testing in Cardiovascular Diseases: A Meta-Analysis of Randomized Controlled Trials

  • Huang Y,
  • Xie Y,
  • Huang L,
  • Han Z

Journal volume & issue
Vol. Volume 19
pp. 279 – 290

Abstract

Read online

Yu Huang,1,2 Yilian Xie,1,3 Lei Huang,1 Zhen Han1,2 1Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Guangdong, 518036, People’s Republic of China; 2Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China; 3Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of ChinaCorrespondence: Zhen Han, Email [email protected]: No consensus has been established on the safety and effectiveness of out-of-hospital management of Vitamin K antagonists (VKA) therapy combining portable coagulometers and telemedicine. The present meta-analysis investigated the safety and effectiveness of this hybrid anticoagulants management model.Methods: The PubMed, Embase, Cochrane, and Web of Science databases were searched for papers published before May 1, 2022. To reduce bias, only randomized controlled trials were included. RevMan 5.3 (Cochrane) software was used to evaluate and analyze clinical outcomes, including the effectiveness and safety of patient management approaches, determined by the time in the therapeutic range (TTR) and occurrence of thrombotic and bleeding events.Results: Eight studies, comprising 3853 patients, were selected. The meta-analysis showed that anticoagulant management combining portable coagulometers and telemedicine significantly improved frequency of testing (mean difference [MD]= 12.95 days; 95% CI, 8.77– 17.12; I2= 92%; P< 0.01) and TTR (MD= 9.50%; 95% CI, 3.16– 15.85; I2= 87%; P< 0.01). Thromboembolism events were reduced (RR= 0.72; 95% CI, 0.51– 1.01; I2= 0%; P= 0.05), but the results were not statistically significant. And no significant differences in major bleeding events, rehospitalization rate, mortality, or overall treatment cost existed between the two groups.Conclusion: Although the safety of remote cardiovascular disease management is not superior to that of conventional outpatient anticoagulant management, it provides a more stable monitoring of coagulation status.Keywords: VKA therapy, warfarin, telemedicine, self-testing, randomized controlled studies, meta-analysis

Keywords