The effect of online versus hospital warfarin management on patient outcomes: a systematic review and meta-analysis

Background Patients using oral anticoagulants are prone both to thrombus from insufficient anticoagulant therapy and to bleeding by overmedication, so there is a need for further exploring. Aim of the review To assess the effect of online management (using electronic communication such as smartphone), and hospital management on the outcome of patients on long-term anticoagulant therapy, and to explore an appropriate anticoagulation management model. Method Studies published in English prior to July 2017 were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library. Two researchers screened the literature independently, extracted the data and evaluated the methodological quality of the included studies. Meta-analysis was conducted using RevMan 5.3 software. The publication bias analysis was evaluated. Results A total of ten studies met the inclusion criteria, covering 16,915 patients. Of these, 8260 cases formed the online anticoagulation management group, and the other 8655 cases the hospital anticoagulant management group. There were no significant differences between the management models for time in therapeutic range, incidence of major or minor bleeding events, thromboembolic events, or warfarin-related emergency department visits. However, online management was associated with fewer warfarin-related hospital admissions than hospital management (odds ratio: 0.47, 95% confidence interval [0.30, 0.73]; P = 0.0009). Conclusion The online management of anticoagulant therapy was not inferior to hospital management, and may provide more convenient, higher quality anticoagulant therapy services for patients.