Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Aug 8, 2020
Date Accepted: Jan 8, 2021
Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: A Cohort Study
ABSTRACT
Background:
In the past years, the internet has enabled considerable progress in the management of chronic diseases, especially hypertension and diabetes. The internet provides novel opportunities in anticoagulation management. International normalized ratio (INR) real-time detection technology is convenient for at-home INR detection. Nevertheless, there is insufficient evidence regarding the effectiveness of online anticoagulation management.
Objective:
This study explored the effectiveness and safety of warfarin management via the Alfalfa app and provided evidence in support of anticoagulant management through online services.
Methods:
In this retrospective, observational cohort study, 860 patients were allocated to either an offline warfarin management group (n = 435) or an Alfalfa app group (n = 425). In the offline warfarin management group, patients either went to the hospital clinic for warfarin management or they managed warfarin doses by themselves following training by medical staff. In the Alfalfa app group, patients downloaded the app on their smartphones and were instructed on how to use the app. The patients reported the dose of warfarin, current INR value, physical status, concurrent medications, and dietary habits through the app. Physicians or pharmacists used the app to adjust the dose of warfarin and determined the time for the next blood INR testing. Patients completed INR testing by point-of-care at home or hospital. The primary outcome of the study was the percentage of time in therapeutic range (TTR). Secondary outcomes included minor and major hemorrhagic events, thrombotic events, warfarin-related emergency department visits, hospital admissions, and high INR values.
Results:
TTR and percentage of INR values were significantly higher in the Alfalfa app group than in the offline warfarin management group (79.35% vs. 51.9%, P < 0.001; 77.39% vs. 47.5%, P ≤ 0.05, respectively). Patients managed via the Alfalfa app had lower rate of subtherapeutic (4.02% vs. 9.24%, P ≤ 0.05), supratherapeutic (11.37% vs. 21.09%, P ≤ 0.05), and extreme subtherapeutic INR values (6.77% vs. 21.77%, P ≤ 0.05). Additionally, the app group had lower incidences of major bleeding (0.47% vs. 2.99%, P = 0.005), warfarin-related emergency department visits (3.06% vs. 9.20%, P < 0.001), and hospital admissions (0.24% vs. 6.86%, P < 0.001) compared with the offline group. However, the Alfalfa app group had higher incidences of minor bleeding than the offline group (10.59% vs. 6.21%, P = 0.020). There were similar incidences in extreme supratherapeutic INR values (0.44 %vs. 0.39%, P = 0.718) and thromboembolic events (0.24 vs. 0.46%, P = 0.578) between the two groups.
Conclusions:
Warfarin management is superior via Alfalfa app than via offline services in terms of major bleeding events, warfarin-related emergency department visits, and hospital admissions. Clinical Trial: Registration number: ChiCTR1900021920
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