Abstract
Warfarin is widely used as an oral anticoagulant. However, it is difficult to manage patients due to its narrow therapeutic range and individualized differences. Using controlled trials and real-world observational studies, this systematic review aimed to analyze health education’s impact among patients on warfarin therapy by mobile application. Smartphone and tablet applications have the potential to actively educate patients by providing them with timely information through push notifications. MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane electronic databases were searched using the keywords “anticoagulants,” “warfarin”, “mobile application”, and “smartphone” up to May 2020. Of the 414 articles obtained, 12 articles met the inclusion criteria for this review. The education and self-management programs using the mobile health application had diverse contents. A meta-analysis was not deemed appropriate because of the heterogeneity of populations, interventions, and outcomes. Thus, a narrative synthesis is presented instead. This review demonstrates that educating patients for anticoagulation management through their smartphones or tablets improves their knowledge levels, medication or treatment adherence, satisfaction, and clinical outcomes. Moreover, it has a positive effect on continuing health care. Future research concerning patients taking warfarin should include key self-management outcomes in larger, more rigorously designed studies, allowing for comparisons across studies. This study proposes a continuous application of timely education through smartphone applications to the current medical and nursing practice.
Highlights
Warfarin remains among the most commonly indicated forms of oral anticoagulant therapy for the prevention and treatment of thromboembolic complications associated with various cardiovascular diseases
This study evaluated the elements and effectiveness of interventions using Mobile health (mHealth) applications on outcomes such as patient knowledge of his or her disease and treatment, treatment guidelines and drug use adherence, prothrombin time levels control, and satisfaction with treatment received
30 articles were identified through the examination of their titles and abstracts that were potentially relevant to the intervention with mHealth applications for control warfarin
Summary
Warfarin remains among the most commonly indicated forms of oral anticoagulant therapy for the prevention and treatment of thromboembolic complications associated with various cardiovascular diseases. Warfarin intake requires special care because it has a narrow therapeutic concentration range. Warfarin’s efficacy and safety require anticoagulation control’s optimal quality. This is demonstrated by a “time in therapeutic range” (TTR). Oral anticoagulation therapy with vitamin K antagonists must be regularly monitored and adjusted. This is important to maintain patients’ international normalized ratio (INR) levels within the target range [4]. Food and drug interactions, alcohol consumption, other diseases, and stress may influence INR values when taking warfarin. Medication adherence and continuous management are important [5]
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