JMIR Publications

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:

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 (RCTs) were searched in five 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 (TTR) were assessed. Results were pooled using random-effects models.

Results:

Twenty-five RCTs were included (25746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Compared to usual care, telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (13 studies, RR: 0.75 95% CI 0.53, 1.07; I²= 42%), comparable rates of major bleeding (11 studies, RR: 0.94, 95% CI 0.82, 1.07; I²= 0%) and mortality (12 studies, RR: 0.96, 95% CI 0.78, 1.20; I²= 11%), and an improved TTR (16 studies, MD: 3.38, 95% CI 1.12, 5.65; I²: 90%). In the subgroup of 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 less thromboembolic events, and a 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. Clinical Trial: PROSPERO (CRD42020159208)