Inventi Impact: Telemedicine

Inventi:etm/17597/15

Quality of Oral Anticoagulation with Phenprocoumon in Regular Medical Care and Its Potential for\nImprovement in a Telemedicine-based Coagulation Service â?? Results from the Prospective, Multicenter,\nObservational Cohort Study ThrombEVAL

Background: The majority of studies on quality of oral anticoagulation (OAC) therapy with vitamin K-antagonists\nare performed with short-acting warfarin. Data on long-acting phenprocoumon, which is frequently used in Europe\nfor OAC therapy and is considered to enable more stable therapy adjustment, are scarce. In this study, we aimed to\nassess quality of OAC therapy with phenprocoumon in regular medical care and to evaluate its potential for\noptimization in a telemedicine-based coagulation service.\nMethods: In the prospective observational cohort study program thrombEVAL we investigated 2,011 patients from\nregular medical care in a multi-center cohort study and 760 patients from a telemedicine-based coagulation service\nin a single-center cohort study. Data were obtained from self-reported data, computer-assisted personal interviews,\nand laboratory measurements according to standard operating procedures with detailed quality control. Time in\ntherapeutic range (TTR) was calculated by linear interpolation method to assess quality of OAC therapy. Study\nmonitoring was carried out by an independent institution.\nResults: Overall, 15,377 treatment years and 48,955 international normalized ratio (INR) measurements were\nanalyzed. Quality of anticoagulation, as measured by median TTR, was 66.3% (inte rquartile range (IQR) 47.8/81.9) in\nregular medical care and 75.5% (IQR 64.2/84.4) in the coagulation service (P <0.001). Stable anticoagulation control\nwithin therapeutic range was achieved in 63.8% of patients in regular medical care with TTR at 72.1% (IQR 58.3/\n84.7) as compared to 96.4% of patients in the coagulation service with TTR at 76.2% [(IQR 65.6/84.7); P = 0.001)].\nProspective follow-up of coagulation service patients with pretreatment in regular medical care showed an\nimprovement of the TTR from 66.2% (IQR 49.0/83.6) to 74.5% (IQR 62.9/84.2; P <0.0001) in the coagulation service.\nTreatment in the coagulation service contributed to an optimization of the profile of time outside therapeutic\nrange, a 2.2-fold increase of stabile INR adjustment and a significant decrease in TTR variability by 36% (P <0.001).\n(Continued on next page)