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      Do telehealth interventions improve oral anticoagulation management? A systematic review and meta-analysis.

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          Abstract

          The benefits and harms of telehealth interventions compared to usual care for oral anticoagulation management are unclear. A systematic review and meta-analysis was conducted to assess their impact on clinically important outcomes. A search was conducted through MEDLINE, EMBASE and CENTRAL databases, and the retrieved citations were independently screened and extracted by two review authors. Cochrane Collaboration-recommended tools were used to assess for risk of bias. Co-primary outcomes were major bleeding and major thromboembolic events. Of 2145 retrieved citations, 7 were included for qualitative synthesis (1 randomized controlled trial, 1 prospective cohort and 5 retrospective cohorts). None addressed direct oral anticoagulants. Telehealth interventions were mainly consisted of telephone visits by clinicians, pharmacists and specialists. Meta-analysis of 3 studies (n = 6955) showed significant improvements in the telehealth group for major thromboembolic events (RR 0.43, 95% CI 0.25-0.74, p = 0.002), but no significant difference for major bleeding events (RR 0.83, 95% CI 0.52-1.33, p = 0.44). There was no significant difference in any of the secondary outcomes. The overall GRADE quality of evidence was rated very low due to high risk of bias and low precision. Based on very low quality evidence, telehealth interventions may lower the risk of major thromboembolic events, but not other clinically important outcomes. A high quality study is likely to strongly influence these results. High quality randomized trials are recommended to better assess the benefits and harms of telehealth interventions for anticoagulation management.

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          Author and article information

          Journal
          J Thromb Thrombolysis
          Journal of thrombosis and thrombolysis
          Springer Science and Business Media LLC
          1573-742X
          0929-5305
          Apr 2018
          : 45
          : 3
          Affiliations
          [1 ] Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
          [2 ] Division of Clinical Pharmacology and Toxicology, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
          [3 ] Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
          [4 ] Division of Clinical Pharmacology and Toxicology, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada. holbrook@mcmaster.ca.
          [5 ] Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, c/o SJHH G623, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. holbrook@mcmaster.ca.
          [6 ] Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada. holbrook@mcmaster.ca.
          Article
          10.1007/s11239-018-1609-2
          10.1007/s11239-018-1609-2
          29350322
          6ab0eb0c-bb18-4b47-89bc-158b4ec4878c
          History

          Anticoagulants,Patient management,Systematic review,Telehealth,Telemedicine

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