多年来,互联网在慢性病管理方面取得了长足的进步,尤其是高血压和糖尿病。它还为在线抗凝管理提供了新的机会。然而,关于在线抗凝管理有效性的证据不足.
本研究通过苜蓿应用探索了华法林管理的有效性和安全性,从而通过在线服务提供支持抗凝剂管理的证据。
在这次回顾展中,观察性队列研究,包括824例患者。在脱机组中,患者前往医院诊所接受华法林治疗。在苜蓿应用组中,患者报告华法林的剂量,当前国际标准化比率(INR)值,和其他相关信息通过苜蓿应用程序。医师或药剂师使用该应用程序调整华法林的剂量,并确定下一次血液INR测试的时间。患者在家中或医院通过即时护理完成INR测试。研究的主要结果是治疗范围内的时间百分比(TTR)。次要结局包括轻微和主要出血事件,血栓形成事件,华法林相关急诊科就诊,入院,高INR值。
苜蓿应用组的TTR和INR值百分比明显高于离线组(79.35%vs52.38%,P<.001;3314/4282,77.39%vs2005/4202,47.72%,分别为P<.001)。通过苜蓿应用程序管理的患者亚治疗率较低(172/4282,4.02%vs388/4202,9.23%;P<.001),超治疗性(487/4282,11.37%vs882/4202,20.99%;P<.001),和极端亚治疗INR值(290/4282,6.77%vs910/4202,21.66%;P<.001)。此外,苜蓿组大出血发生率较低(2/425,0.5%vs12/399,3.0%;P=.005),与华法林相关的急诊科就诊(13/425,3.1%vs37/399,9.3%;P<.001),与离线组相比,住院人数(1/425,0.2%vs12/399,3.0%;P=.001)。然而,苜蓿app组的轻微出血发生率高于离线组(45/425,10.6%vs20/399,5.0%;P=.003).两组间极端超治疗INR值(19/4282,0.44%vs17/4202,0.40%;P=0.78)和血栓栓塞事件(1/425,0.2%vs1/399,0.3%;P=0.53)发生率相似。
在严重出血事件方面,通过苜蓿应用程序进行华法林管理优于通过离线服务,华法林相关急诊科就诊,和入院。
Over the years, the internet has enabled considerable progress in the management of chronic diseases, especially hypertension and diabetes. It also provides novel opportunities in online anticoagulation management. Nevertheless, there is insufficient evidence regarding the effectiveness of online anticoagulation management.
This
study explored the effectiveness and safety of warfarin management via the Alfalfa app, so as to provide evidence in support of anticoagulant management through online services.
In this retrospective, observational cohort
study, 824 patients were included. In the offline group, patients went to the hospital clinic for warfarin management. In the Alfalfa app group, patients reported the dose of warfarin, current international normalized ratio (INR) value, and other related information through the Alfalfa 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 bleeding events, thrombotic events, warfarin-related emergency department visits, hospital admissions, and high INR values.
The
TTR and percentage of INR values in the range were significantly higher in the Alfalfa app group than in the offline group (79.35% vs 52.38%, P<.001; 3314/4282, 77.39% vs 2005/4202, 47.72%, P<.001, respectively). Patients managed via the Alfalfa app had lower rates of subtherapeutic (172/4282, 4.02% vs 388/4202, 9.23%; P<.001), supratherapeutic (487/4282, 11.37% vs 882/4202, 20.99%; P<.001), and extreme subtherapeutic INR values (290/4282, 6.77% vs 910/4202, 21.66%; P<.001). Additionally, the Alfalfa app group had lower incidences of major bleeding (2/425, 0.5% vs 12/399, 3.0%; P=.005), warfarin-related emergency department visits (13/425, 3.1% vs 37/399, 9.3%; P<.001), and hospital admissions (1/425, 0.2% vs 12/399, 3.0%; P=.001) compared with the offline group. However, the Alfalfa app group had a higher incidence of minor bleeding than the offline group (45/425, 10.6% vs 20/399, 5.0%; P=.003). There were similar incidences in extreme supratherapeutic INR values (19/4282, 0.44% vs 17/4202, 0.40%; P=.78) and thromboembolic events (1/425, 0.2% vs 1/399, 0.3%; P=.53) between the two groups.
Warfarin management is superior via the Alfalfa app than via offline services in terms of major bleeding events, warfarin-related emergency department visits, and hospital admissions.