Technological interventions may improve patient care with oral anticoagulants

Technology may be tapped to manage oral anticoagulant (OAC) medications to help improve their safety and efficacy and, in turn, boost patient satisfaction, according to a recent meta-analysis.

“The technology-based interventions used to manage OAC typically include multiple methods, including telephone, internet, voicemail messaging, and apps. These tools are readily available in this era of technological advancement, and they reduce requirements for capacity and waiting time in outpatient clinics,” researchers said.

Fifteen randomized controlled trials were pooled, corresponding to 2,218 patients, of whom 1,110 received active technology interventions, while the remaining 1,108 were set as controls. Nine of these studies included data on the time within target range (TTR). Random-effects meta-analaysis showed that patients who had technology-based interventions had a significantly longer TTR (mean difference [MD], 6.07, 95 percent confidence interval [CI], 0.84–11.30; p=0.02). [J Med Internet Res 2020;22:e18386]

Eleven studies assessed thromboembolism events, with a total pooled sample of 1,959 patients. Researchers saw that patients who were using technology-based interventions sustained fewer thromboembolism events, with a borderline-significant effect (MD, 0.71, 95 percent CI, 0.49–1.01; p=0.06).

Major bleeding events were reported in 14 of the 15 studies, including 2,139 patients. Those who were on technology-based interventions saw fewer events, though the difference was not statistically significant (MD, 1.02, 95 percent CI, 0.78–1.32; p=0.90).

Minor bleeding was likewise rarer in patients who were using technology-based interventions (MD, 1.06, 95 percent CI, 0.77–1.44; p=0.73).

“Our overall results showed that technology-based interventions significantly improved the effectiveness of OAC management but did not significantly increase the safety or other results of OAC management,” researchers said. In the studies included, most of the participants were above the age of 60 years, which may have affected their use patterns of such technologies.

“The telephone is an ultra-portable electronic device, and it was chosen as the intervention tool in most of the 15 RCT studies included,” they added. “Telephone intervention is especially suitable for older patients who are not accustomed to using computers or online services, or who may have difficulties in vision, finger dexterity, and mental state.”

Notably, the present study also found that telemedicine interventions improved patient knowledge about anticoagulation, as well as their quality of life, while reducing overall costs for care. Patient satisfaction surveys, conducted in five of the included studies, suggested that patient satisfaction was better in groups that received the technological interventions.

“OAC management through technology-based intervention appears to be superior to OAC management through traditional intervention and may provide more convenient and higher quality anticoagulation services for patients,” researchers said.

“Further research is needed to explore more optimal technology-based interventions in OAC management in a wider array of healthcare settings.”