Abstract
BACKGROUND: Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. OBJECTIVE: The 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. METHODS: Randomized 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. RESULTS: In 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). CONCLUSIONS: Telemedicine-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 REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208.
| Original language | English |
|---|---|
| Pages (from-to) | e45922 |
| Journal | Journal of Medical Internet Research |
| Volume | 25 |
| Early online date | 22 Jan 2023 |
| DOIs | |
| Publication status | Published - 10 Jul 2023 |
Bibliographical note
Copyright: ©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, Antoni Ribeiro, Milena Soriano Marcolino.This study is supported in part by National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq grant 428433/2016-2), National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde—IATS)/CNPq (grant 465518/2014-1), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES grant 88887.507149/2020-00), and Brazilian Ministry of Education (MEC—27849*8). MSM was supported in part by CNPq (grant 310561/2021-3). AR is supported in part by CNPq (310790/2021-2) and by Minas Gerais State Agency for Research and Development (FAPEMIG PPM-00428-17 and RED-00081-16). LFAM and TMP received scholarships from Pró-Reitoria de Extensão from Federal University of Minas Gerais (PROEX UFMG).