JMIR Publications

ABSTRACT

Background:

Increasing numbers of patients receive prophylactic or therapeutic oral anticoagulants (OACs) for thromboembolic complications of diseases. The use of OACs brings 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 patients’ clinical benefits 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, CINAHL, 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. RevMan5.3 software was used to evaluate and analyze clinical outcomes. The methodological quality of studies was assessed by the Cochrane Collaboration risk of bias tool.

Results:

A total of 15 randomized controlled trials (RCTs) was 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% confidence interval [CI], 0.84 to 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 to 1.32, I2=0%, P=.90; minor bleeding events MD=1.06, 95% CI, 0.77 to 1.44, I2=41%, P=.73) and thromboembolism events were reduced (MD=0.71, 95% CI, 0.49 to 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 mastery of the relevant knowledge of anticoagulation.