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Erschienen in: Journal of Thrombosis and Thrombolysis 3/2018

19.01.2018

Do telehealth interventions improve oral anticoagulation management? A systematic review and meta-analysis

verfasst von: Munil Lee, Mei Wang, Jiayu Liu, Anne Holbrook

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 3/2018

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Abstract

The benefits and harms of telehealth interventions compared to usual care for oral anticoagulation management are unclear. A systematic review and meta-analysis was conducted to assess their impact on clinically important outcomes. A search was conducted through MEDLINE, EMBASE and CENTRAL databases, and the retrieved citations were independently screened and extracted by two review authors. Cochrane Collaboration-recommended tools were used to assess for risk of bias. Co-primary outcomes were major bleeding and major thromboembolic events. Of 2145 retrieved citations, 7 were included for qualitative synthesis (1 randomized controlled trial, 1 prospective cohort and 5 retrospective cohorts). None addressed direct oral anticoagulants. Telehealth interventions were mainly consisted of telephone visits by clinicians, pharmacists and specialists. Meta-analysis of 3 studies (n = 6955) showed significant improvements in the telehealth group for major thromboembolic events (RR 0.43, 95% CI 0.25–0.74, p = 0.002), but no significant difference for major bleeding events (RR 0.83, 95% CI 0.52–1.33, p = 0.44). There was no significant difference in any of the secondary outcomes. The overall GRADE quality of evidence was rated very low due to high risk of bias and low precision. Based on very low quality evidence, telehealth interventions may lower the risk of major thromboembolic events, but not other clinically important outcomes. A high quality study is likely to strongly influence these results. High quality randomized trials are recommended to better assess the benefits and harms of telehealth interventions for anticoagulation management.
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Literatur
2.
Zurück zum Zitat Ghanny S, Crowther M (2013) Treatment with novel oral anticoagulants: indications, efficacy and risks. Curr Opin Hematol 20(5):430–436CrossRefPubMed Ghanny S, Crowther M (2013) Treatment with novel oral anticoagulants: indications, efficacy and risks. Curr Opin Hematol 20(5):430–436CrossRefPubMed
3.
Zurück zum Zitat Bayoumi I et al (2014) Medication-related emergency department visits and hospitalizations among older adults. Can Fam Physician 60(4):e217–e222PubMedPubMedCentral Bayoumi I et al (2014) Medication-related emergency department visits and hospitalizations among older adults. Can Fam Physician 60(4):e217–e222PubMedPubMedCentral
4.
Zurück zum Zitat Tamayo Aguirre E et al (2016) Oral anticoagulation with vitamin K inhibitors and determinants of successful self-management in primary care. BMC Cardiovasc Disord 16(1):180CrossRefPubMedPubMedCentral Tamayo Aguirre E et al (2016) Oral anticoagulation with vitamin K inhibitors and determinants of successful self-management in primary care. BMC Cardiovasc Disord 16(1):180CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Heneghan CJ et al (2016) Self-monitoring and self-management of oral anticoagulation, in Cochrane Database of Systematic Reviews. Wiley, Hoboken Heneghan CJ et al (2016) Self-monitoring and self-management of oral anticoagulation, in Cochrane Database of Systematic Reviews. Wiley, Hoboken
7.
Zurück zum Zitat Flodgren G et al (2015) Interactive telemedicine: effects on professional practice and health care outcomes, in Cochrane Database of Systematic Reviews. Wiley, Hoboken Flodgren G et al (2015) Interactive telemedicine: effects on professional practice and health care outcomes, in Cochrane Database of Systematic Reviews. Wiley, Hoboken
8.
Zurück zum Zitat Totten A, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, Hersh WR (2016) Telehealth: mapping the evidence for patient outcomes from systematic reviews. Technical Brief No. 26, Agency for Healthcare Research and Quality, Rockville Totten A, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, Hersh WR (2016) Telehealth: mapping the evidence for patient outcomes from systematic reviews. Technical Brief No. 26, Agency for Healthcare Research and Quality, Rockville
11.
Zurück zum Zitat Schmitt L, Speckman J, Ansell J (2003) Quality assessment of anticoagulation dose management: comparative evaluation of measures of time-in-therapeutic range. J Thromb Thrombolysis 15:213–216CrossRefPubMed Schmitt L, Speckman J, Ansell J (2003) Quality assessment of anticoagulation dose management: comparative evaluation of measures of time-in-therapeutic range. J Thromb Thrombolysis 15:213–216CrossRefPubMed
13.
15.
Zurück zum Zitat Guyatt GH, Oxman AD, Vist EV, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924CrossRefPubMedPubMedCentral Guyatt GH, Oxman AD, Vist EV, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Review Manager (RevMan) (2014), The Cochrane Collaboration: Copenhagen: The Nordic Cochrane Centre Review Manager (RevMan) (2014), The Cochrane Collaboration: Copenhagen: The Nordic Cochrane Centre
17.
Zurück zum Zitat Staresinic AG et al (2006) Comparison of outcomes using 2 delivery models of anticoagulation care. Arch Intern Med 166(9):997–1006CrossRefPubMed Staresinic AG et al (2006) Comparison of outcomes using 2 delivery models of anticoagulation care. Arch Intern Med 166(9):997–1006CrossRefPubMed
18.
Zurück zum Zitat Keller K et al (2015) Clinical outcome of patients with venous thromboembolism under oral anticoagulation in regular medical care versus a telemedicine-based anticoagulation clinic. Eur Heart J 36:861 Keller K et al (2015) Clinical outcome of patients with venous thromboembolism under oral anticoagulation in regular medical care versus a telemedicine-based anticoagulation clinic. Eur Heart J 36:861
19.
Zurück zum Zitat Blissit KT, Mullenix ML, Brittain KG (2015) Evaluation of time in therapeutic range on Warfarin therapy between face-to-face and telephone follow-up in a VA Medical Center. J Pharm Technol 31(2):78–83CrossRef Blissit KT, Mullenix ML, Brittain KG (2015) Evaluation of time in therapeutic range on Warfarin therapy between face-to-face and telephone follow-up in a VA Medical Center. J Pharm Technol 31(2):78–83CrossRef
20.
Zurück zum Zitat Gubensek M, Mavri A (2009) Quality of telephone-based management of oral anticoagulation treatment. J Thromb Haemost 7(S2):454–455 Gubensek M, Mavri A (2009) Quality of telephone-based management of oral anticoagulation treatment. J Thromb Haemost 7(S2):454–455
21.
Zurück zum Zitat Stoudenmire LG, De Remer CE, Elewa H (2014) Telephone versus office-based management of warfarin: impact on international normalized ratios and outcomes. Am J Hematol 89(6):E6 Stoudenmire LG, De Remer CE, Elewa H (2014) Telephone versus office-based management of warfarin: impact on international normalized ratios and outcomes. Am J Hematol 89(6):E6
22.
Zurück zum Zitat Witt DM et al (2005) Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest 127(5):1515–1522CrossRefPubMed Witt DM et al (2005) Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest 127(5):1515–1522CrossRefPubMed
23.
Zurück zum Zitat Wittkowsky AK et al (2006) Outcomes of oral anticoagulant therapy managed by telephone vs in office visits in an anticoagulation clinic setting. Chest 130(5):1385–1389CrossRefPubMed Wittkowsky AK et al (2006) Outcomes of oral anticoagulant therapy managed by telephone vs in office visits in an anticoagulation clinic setting. Chest 130(5):1385–1389CrossRefPubMed
24.
Zurück zum Zitat Ekeland AG, Bowes A, Flottorp S (2010) Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform 79(11):736–771CrossRefPubMed Ekeland AG, Bowes A, Flottorp S (2010) Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform 79(11):736–771CrossRefPubMed
27.
Metadaten
Titel
Do telehealth interventions improve oral anticoagulation management? A systematic review and meta-analysis
verfasst von
Munil Lee
Mei Wang
Jiayu Liu
Anne Holbrook
Publikationsdatum
19.01.2018
Verlag
Springer US
Erschienen in
Journal of Thrombosis and Thrombolysis / Ausgabe 3/2018
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-018-1609-2

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