The influence of internet-based telemedicine on warfarin management: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

ABSTRACT

@#Objective    To systematically evaluate the effects of telemedicine on the management of warfarin therapy. Methods    We searched PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang Database (from inception to February 2020) and conducted retrospective literature searching to identify studies about the management of warfarin using telemedicine intervention techniques. R language software was used to evaluate the efficacy and safety of telemedicine on warfarin management. Results    A total of 7 239 articles were retrieved, and 12 articles were finally included according to inclusion and exclusion criteria, totaling 8 112 patients, including 3 726 patients in the intervention group and 4 386 patients in the control group. The results of meta-analysis showed that there was a statistical difference in the accurate international normalized ratio (INR) treatment target range time ratio between the intervention group and the control group (MD=6.52, 95%CI 2.13 to 10.92, P<0.01, I2=89%). The incidence of bleeding events (RR=0.61, 95%CI 0.46 to 0.81, P=0.97, I2=0%) and the incidence of thromboembolic events (RR=0.50, 95%CI 0.29 to 0.85, P=0.63, I2=0%) were not statistically different between the two groups. Conclusion    Existing evidence indicates that telemedicine management has a benefit in anticoagulant efficacy compared with conventional anticoagulant management in patients with thrombotic diseases, but there is no statistical difference in safety. Limited by the quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.