Table 2.
Characteristics of included studies.
| Authors, publication year | Registration number | Value, n | Age (years), mean | % male sex | Indications for anticoagulation | Description of the intervention | Drug | Follow-up (months), mean | Primary outcome | Thromboembolic events: intervention (%)/ control (%) |
Major bleeding: intervention (%)/ control (%) |
Mortality: intervention (%)/ control (%) |
TTRa: intervention (%)/ control (%) |
| Ageno et al (1998) [32] | N/Ab | 101 | 52 | N/A | Valvular heart disease: 100% | Computer-assisted algorithm for anticoagulant dose adjustment made by phone or fax | Warfarin | 10 | Average number of INRc tests | N/A | N/A | N/A | 55.2/ 55.3 |
| Ayutthaya et al (2018) [7] | TCTR20180614006 | 50 | 57.6 | 40 | AFd: 62% DVTe/PEf: 30% Valvular heart disease: 34% |
Telephone follow-up by pharmacists | Warfarin | 3 | TTR (Rosendaal method), number of patients with out-of-range INR | 12/ 24 |
8/4 | 0/4 | 49.8/ 28 |
| Borgman et al (2012) [28] | NCT00993200 | 26 | 53 | 54 | AF: 34.5% DVT: 46% Cerebrovascular disease: 7% |
Computer-assisted algorithm for anticoagulant dose adjustment (genotype information added) | Warfarin | 3 | Time to first stable therapeutic INR | N/A | N/A | N/A | 77.7/ 70.3 |
| Christensen et al (2011) [30] | N/A | 123 | N/A | 74.8 | AF: 53.4% Cerebrovascular disease: 9.7% DVT/PE: 16.3% Valvular heart disease: 12.5% Others: 13.2% |
Self-testing and dose adjustments made through a web-based system | Warfarin | 11 | TTR (Rosendaal method) | N/A | N/A | 0/0 | 79.9/ 72.7 |
| Cox et al (2020) [19] | NCT01927367 | 1133 | 72.3 | 61.8 | AF: 100% | Web-based, point-of-care CDSSg designed to enable rapid, evidence-based treatment of AF | Warfarin and DOACh (29%) | 12 | AF-related emergency department visit or unplanned cardiovascular hospitalization, and major bleeding | N/A | 1.5/ 1.2 |
4.7/ 3.8 |
N/A |
| Fihn et al (1994) [20] | N/A | 620 | 61 | 71 | AF: 17% Cerebrovascular disease: 10% Systemic embolism: 6% DVT/PE: 26% Others: 42% |
Computer-generated recommendation for scheduling the next visit | Warfarin | 8 | Follow-up interval scheduled and the quality of anticoagulation control | 1.9/ 0.9 |
4.3/ 4.7 |
0/0 | N/A |
| Fitzmaurice et al (1996) [27] | N/A | 23 | N/A | N/A | AF: 13% Systemic embolism: 4.3% DVT/PE: 43.4% Valvular heart disease: 30.4% Others: 8.6% |
Computer-assisted algorithm for anticoagulant dose adjustment | Warfarin | 12 | Percentage of INR results in therapeutic range | 7.1/0 | 0/0 | 7.1/ 14.3 |
N/A |
| Fitzmaurice et al (2000) [17] | N/A | 367 | N/A | 55 | AF: 48% Cerebrovascular disease: 4% Systemic embolism: 2% DVT/PE: 20% Valvular heart disease: 16% |
Near-patient testing and computer-assisted algorithm for anticoagulant dose adjustment | Warfarin | 12 | INR control (point prevalence of patients achieving individual therapeutic INR targets) and TTR | 1.6/4 | 0/0 | 2.4/ 2.5 |
69/ 62 |
| Fitzmaurice et al (2002) [9] | N/A | 49 | 65 | 75.5 | AF: 55.1% Others: 44.9% |
Self-testing and self-management of anticoagulation. Remote support available through pager and telephone | Warfarin | 6 | TTR (method not mentioned) | N/A | 0/3.8 | 0/3.8 | 74/ 77 |
| Gadisseur et al (2003) [23] | N/A | 320 | 58.5 | 71.3 | AF: 21.3% Cerebrovascular disease: 1.3% Systemic embolism: 2.2% DVT/PE: 20.3% Valvular heart disease: 19.1% Others: 35.6% |
Self-testing with or without self-management of OATi by patients (phone support by the anticoagulation clinic) | Phenprocoumon and acenocoumarol | 6 | Quality of anticoagulation therapy; thromboembolic and hemorrhagic events | 0/0 | 2/1.4 | N/A | 67.7/ 64.7 |
| Guo et al (2020) [40] | ChiCTR-OOC-17014138 | 2473 | 68.9 | 62 | AF: 100% | Use of mobile app for integrated management of AF, including anticoagulation management | VKAsj and DOACs (60%) | 20 | Composite of stroke, thromboembolism, all-cause death, and rehospitalization | 0.8/5 | 0/0.4 | 0.9/ 2.6 |
N/A |
| Khan et al (2004) [37] | N/A | 79 | 73 | 60 | AF: 100% | Self-testing and dose adjustment made by physician by telephone | Warfarin | 6 | TTR (Rosendaal method) | N/A | N/A | N/A | 71.1/ 70.4 |
| Manotti et al (2001) [35] | N/A | 1251 | 67.1 | 54.8 | Systemic embolism: 26% DVT/PE: 21.2% Valvular heart disease: 14.6% Others: 38.1% |
Computer-assisted algorithm for anticoagulant dose adjustment | Warfarin and acenocoumarol | 8.1 | Percentage of patients reaching a stable INR and TTR (Rosendaal method) | N/A | N/A | N/A | 71.2/ 68.2 |
| Matchar et al (2010) [24] | NCT00032591 | 2922 | 67 | 98 | AF: 76.5% Valvular heart disease: 23.4% |
Self-testing and dose adjustments made by phone, after communication of results using interactive voice-response system | Warfarin | 36 | Time to first major event (stroke, major bleeding episode, or death) | 4.8/ 5.6 |
12.2/ 13.6 |
10.3/ 10.7 |
66.2/ 62.4 |
| Nieuwlaat et al (2012) [25] | NCT01024452 | 1298 | 68.6 | 62.3 | AF: 47.7% Cerebrovascular disease: 3.6% Valvular heart disease: 25.1% DVT/PE: 15.8% Others: 7.9% |
Computer-assisted algorithm for anticoagulant dose adjustment and scheduling the next visit | Warfarin | 5.3 | TTR (Rosendaal method) | N/A | N/A | N/A | 71/ 71.9 |
| Poller et al (1993) [31] | N/A | 186 | 64.5 | 57.5 | AF: 12.4% Cerebrovascular disease: 5.4% Systemic embolism: 30.1% Valvular heart disease: 8.1% DVT/PE: 39.8% Others: 4.3% |
Computer-assisted algorithm for anticoagulant dose adjustment | Warfarin | 6 | Binary indicator for out-of-range INR | N/A | 0/0 | 0.8/0 | N/A |
| Poller et al (1998) [26] | N/A | 285 | N/A | N/A | N/A | Computer-assisted algorithm for anticoagulant dose adjustment | Warfarin and acenocoumarol | N/A | TTR (Rosendaal method) | N/A | N/A | N/A | 63.3/ 53.2 |
| Poller et al (2008) [21] | N/A | 13,052 | 66.9 | 53.5 | AF: 45.6% DVT/PE: 24.5% Valvular heart disease: 13% Others: 16.8% |
Computer-assisted algorithm for anticoagulant dose adjustment | Warfarin, acenocoumarol, and phenprocoumon | N/A | Incidence of clinical events (bleeding or thrombotic) | 1.4/ 1.6 |
1.4/ 1.5 |
1.1/ 0.9 |
65.9/ 64.7 |
| Rasmussen et al (2012) [29] | N/A | 54 | 70 | 57 | N/A | Computer-assisted algorithm for anticoagulant dose adjustment | Warfarin | 7 | TTR (Rosendaal method) | N/A | N/A | N/A | 53.1/ 55 |
| Sidhu and O’Kane (2001) [8] | N/A | 100 | 60.9 | 46 | Valvular heart disease: 100% | Self-testing and self-management of anticoagulation. Physician available remotely for doubts | Warfarin | 24 | Number of tests in therapeutic range and TTR (Rosendaal method) | 21.9/ 22.9 |
2.4/0 | 0/8.3 | 76.6/ 63.8 |
| Staresinic et al (2006) [33] | N/A | 192 | 69.3 | 97.4 | AF: 41.1% Stroke: 9.9% DVT/PE: 12% Valvular heart disease: 18.8% Others: 18.2% |
Laboratory testing of INR. dose adjustment and counseling made by phone contact by the clinic staff | Warfarin | 36 | TTR (Rosendaal method) | 4/9.5 | 49/ 45.7 |
13.2/ 9.5 |
57.8/ 55.1 |
| Vadher et al (1997) [22] | N/A | 177 | 62.9 | 56.5 | N/A | Computer-assisted algorithm for anticoagulant dose adjustment | Warfarin | N/A | TTR (Rosendaal method) | 5.4/ 2.2 |
N/A | N/A | 60.7/ 51.6 |
| Verret et al (2012) [38] | NCT01033279 | 114 | 57.7 | 68 | AF: 50.8% Valvular heart disease: 42.1% Others: 7% |
Self-testing and self-management of anticoagulation. Pharmacist supervision through voicemail messages and telephone contact | Warfarin | 4 | Anticoagulation-related quality of life | 0/0 | 3.4/ 1.7 |
0/0 | N/A |
| Vogeler et al (2021) [34] | N/A | 30 | 61 | 93.5 | LVADk: 100% | Self-testing, results transmitted via telemedicine device, and remote dose adjustment by clinic staff | Warfarin and phenprocoumon | 12 | TTR (Rosendaal method) | 26/ 6.6 |
N/A | N/A | 58/ 78 |
| Zhu et al (2021) [36] | ChiCTR1800016204 | 721 | 50.1 | 61 | Valvular heart disease: 100% | Internet-based anticoagulation management via a mobile user interface medical platform | Warfarin | 12 | TTR (Rosendaal method) | 0.2/ 0.5 |
0.5/ 1.1 |
0/0.5 | 53/ 46 |
aTTR: time in therapeutic range.
bN/A: not available.
cINR: international normalized ratio.
dAF: atrial fibrillation.
eDVT: deep venous thrombosis.
fPE: pulmonary embolism.
gCDSS: clinical decision support system.
hDOAC: direct oral anticoagulant.
iOAT: oral anticoagulation therapy.
jVKA: vitamin K antagonist.
kLVAD: left ventricular assist device.