Telemanagement of anticoagulant therapy for patients after mechanical heart valve replacement: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jinze , DONG Yijun , QIAN Yongjun ,  DONG Li

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

DONG Li, Email: donglikn199@163.com

Keywords：

Heart valve replacement; anticoagulant therapy; telemanagement; time in therapeutic rang; fraction in therapeutic range

DOI：

10.7507/1007-4848.201811046

Video：

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Objective To explore the safety and efficacy of mobile APP in telemanagement for patients who received oral warfarin anticoagulant therapy after mechanical heart valve replacement. Methods A prospective cohort study was performed. According to the inclusion and exclusion criteria, a total of 80 patients who underwent mechanical heart valve replacement for more than half a year and received oral warfarin anticoagulant therapy in outpatient department were included in our hospital from January 1, 2017 to December 31, 2017. These patients were divided into a telemanagement group (40 paitents, telemanagement using mobile APP) and a control group (40 patients, anticoagulant management in outpatient clinics) according to patients' wishes and local hospital international normalized ratio (INR) monitoring conditions. After 12-month follow-up, clinical effect of the two groups was compared. The INR, time in therapeutic range (TTR), fraction in therapeutic range (FTTR), anticoagulation-related complications and patient satisfaction were analyzed. Results During the follow-up period of anticoagulation, there was no significant difference in INR between the two groups (P=0.732). The average interval of INR monitoring in the telemanagement group was 3-65 (21.4 ± 12.5) days, while that in the control group was 7-93 (39.6 ± 14.7) days (P=0.012). TTR was 42.7% (6 027.6 d/14 116.0 d) in the control group and 67.9% (10 168.6 d/14 972.0 d) in the telemanagement group (P=0.018). And FTTR in the two groups was 45.6% (144/316) and 67.1% (432/644), respectively (P=0.015). No serious thromboembolism or hemorrhage events occurred in the 80 patients during the 12-month follow-up period. There was no significant difference in the incidence of anticoagulation-related complications, general bleeding and embolism between the two groups (P>0.05). Conclusion For patients with stable anticoagulation after cardiac mechanical valve replacement, it is safe and effective to telemanagement by mobile APP. Telemanagement can increase the frequency of anticoagulation monitoring without increasing anticoagulation risk, meanwhile, it also could obtain more convenient and rapid consultation, save time and economic costs,and improve the quality of life and patient satisfaction.

Citation： LI Jinze, DONG Yijun, QIAN Yongjun, DONG Li. Telemanagement of anticoagulant therapy for patients after mechanical heart valve replacement: A prospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 343-347. doi: 10.7507/1007-4848.201811046 Copy

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2.	Nagler M, Bachmann LM, Schmid P, et al. Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study. PLoS One, 2014, 9(4): e95761.
3.	Menéndez-Jándula B, Souto JC, Oliver A, et al. Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial. Ann Intern Med, 2005, 142(1): 1-10.
4.	Lakshmy R, Kumar AS. Comparative evaluation of point of care coagulation monitoring by coaguchek XS-comparison with standard laboratory method. Indian J Thorac Cardiovasc Surg, 2010, 26(2): 125-128.
5.	Brasen CL, Madsen JS, Parkner T, et al. Home management of warfarin treatment through a real-time supervised telemedicine solution: A randomized controlled trial. Telemed J E Health, 2019, 25(2): 109-115.
6.	Harper P, Pollock D. Improved anticoagulant control in patients using home international normalized ratio testing and decision support provided through the internet. Intern Med J, 2011, 41(4): 332-337.
7.	Ryan F, Byrne S, O'Shea S. Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system. J Thromb Haemost, 2009, 7(8): 1284-1290.
8.	Lee M, Wang M, Liu J, et al. Do telehealth interventions improve oral anticoagulation management? A systematic review and meta-analysis. J Thromb Thrombolysis, 2018, 45(3): 325-336.
9.	Prochaska JH, Göbel S, Keller K, et al. Quality of oral anticoagulation with phenprocoumon in regular medical care and its potential for improvement in a telemedicine-based coagulation service--results from the prospective, multi-center, observational cohort study thrombEVAL. BMC Med, 2015, 13: 14.
10.	Barcellona D, Fenu L, Cornacchini S, et al. Telemedicine can improve the quality of oral anticoagulation using portable devices and self-testing at home. J Telemed Telecare, 2013, 19(6): 298-301.
11.	董力, 许建屏, 石应康, 等. 中国心脏瓣膜术后多中心低强度抗凝治疗注册登记及随访研究. 中华医学杂志, 2016, 96(19): 1489-1494.
12.	Samsa GP, Matchar DB. Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management. J Thromb Thrombolysis, 2000, 9(3): 283-292.
13.	Herijgers P, Verhamme P. Improving the quality of anticoagulant therapy in patients with mechanical heart valves: what are we waiting for? Eur Heart J, 2007, 28(20): 2424-2426.
14.	Rosendaal FR, Cannegieter SC, van der Meer FJ, et al. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost, 1993, 69(3): 236-239.
15.	Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet, 2006, 367(9508): 404-411.
16.	Gardiner C, Williams K, Mackie IJ, et al. Patient self-testing is a reliable and acceptable alternative to laboratory INR monitoring. Br J Haematol, 2005, 128(2): 242-247.

1. Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. Chest, 2001, 119(1 suppl): 22s-38s.
2. Nagler M, Bachmann LM, Schmid P, et al. Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study. PLoS One, 2014, 9(4): e95761.
3. Menéndez-Jándula B, Souto JC, Oliver A, et al. Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial. Ann Intern Med, 2005, 142(1): 1-10.
4. Lakshmy R, Kumar AS. Comparative evaluation of point of care coagulation monitoring by coaguchek XS-comparison with standard laboratory method. Indian J Thorac Cardiovasc Surg, 2010, 26(2): 125-128.
5. Brasen CL, Madsen JS, Parkner T, et al. Home management of warfarin treatment through a real-time supervised telemedicine solution: A randomized controlled trial. Telemed J E Health, 2019, 25(2): 109-115.
6. Harper P, Pollock D. Improved anticoagulant control in patients using home international normalized ratio testing and decision support provided through the internet. Intern Med J, 2011, 41(4): 332-337.
7. Ryan F, Byrne S, O'Shea S. Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system. J Thromb Haemost, 2009, 7(8): 1284-1290.
8. Lee M, Wang M, Liu J, et al. Do telehealth interventions improve oral anticoagulation management? A systematic review and meta-analysis. J Thromb Thrombolysis, 2018, 45(3): 325-336.
9. Prochaska JH, Göbel S, Keller K, et al. Quality of oral anticoagulation with phenprocoumon in regular medical care and its potential for improvement in a telemedicine-based coagulation service--results from the prospective, multi-center, observational cohort study thrombEVAL. BMC Med, 2015, 13: 14.
10. Barcellona D, Fenu L, Cornacchini S, et al. Telemedicine can improve the quality of oral anticoagulation using portable devices and self-testing at home. J Telemed Telecare, 2013, 19(6): 298-301.
11. 董力, 许建屏, 石应康, 等. 中国心脏瓣膜术后多中心低强度抗凝治疗注册登记及随访研究. 中华医学杂志, 2016, 96(19): 1489-1494.
12. Samsa GP, Matchar DB. Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management. J Thromb Thrombolysis, 2000, 9(3): 283-292.
13. Herijgers P, Verhamme P. Improving the quality of anticoagulant therapy in patients with mechanical heart valves: what are we waiting for? Eur Heart J, 2007, 28(20): 2424-2426.
14. Rosendaal FR, Cannegieter SC, van der Meer FJ, et al. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost, 1993, 69(3): 236-239.
15. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet, 2006, 367(9508): 404-411.
16. Gardiner C, Williams K, Mackie IJ, et al. Patient self-testing is a reliable and acceptable alternative to laboratory INR monitoring. Br J Haematol, 2005, 128(2): 242-247.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Telemanagement of anticoagulant therapy for patients after mechanical heart valve replacement: A prospective cohort study

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