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CME Evaluation

Oral Communication Session

Venous Thromboembolism

Session: Improving outcomes in VTE

OC 52.3 - Randomized interventions aimed to improve oral anticoagulation outcomes, a systematic review and meta-analysis

Tuesday, June 25, 2024
10:00 – 10:15 ICT
Room: Ballroom B2

    Presenting Author(s)

  • Tessa Elling, MD

    PhD-student
    Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
    Groningen, Groningen, Netherlands

    • Co-Author(s)

  • DM

    Darko Mitrovic

    MD PhD
    Department of Hospital Pharmacy, Tjongerschans, Heerenveen, The Netherlands
    Heerenveen, Friesland, Netherlands

  • Pv

    Patricia M.L.A van den Bemt

    Prof. Dr.
    Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
    Groningen, Groningen, Netherlands

  • NV

    Nic J.G.M. Veeger

    Clinical epidemiologist, PhD
    Department of Clinical Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    Groningen, Groningen, Netherlands

  • Karina Meijer

    MD, PhD, professor
    Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    Groningen, Groningen, Netherlands

Background: Anticoagulation care aims to prevent thromboembolic events and minimize adverse outcomes. While many interventions aimed at optimizing anticoagulation care hold promise, their effectiveness remains unclear.

Aims: This systematic review and meta-analysis evaluated the effect of interventions aimed to improve anticoagulation outcomes.

Methods: We systematically searched Pubmed, EMBASE and the Cochrane library until December 1, 2023. We included randomized controlled trials (RCTs) comparing interventions, including educational, behavioral, and others, to usual care in adult patients (PROSPERO: CRD42021226692). Two authors independently screened titles, abstracts and full texts, assessed bias using the Cochrane risk-of-bias tool, and evaluated evidence quality with the GRADE system. Data extraction was performed by one author and cross-verified by a second for accuracy. Outcome variables included time in therapeutic range (TTR), anticoagulation adherence and persistence, venous thromboembolism (VTE), bleeding events and mortality.

Results: We included 94 RCTs, in which 32 educational, 27 behavioral, 62 other interventions were compared (table 1), comprising 40,161 patients (84.4% VKA, 10.7% DOAC). Most outcomes had low-quality evidence.

Educational interventions resulted in higher TTR values (standardized mean difference (SMD) 0.51, 95% CI 0.19-0.83) and increased adherence rates (SMD 0.40, 95% CI 0.12-0.67). These were lower in low-risk bias studies. Additionally, there were fewer minor bleeds (relative risk (RR) 0.46, 95%CI 0.31-0.67), major bleeds (RR 0.72, 95% CI 0.55-0.94), and a larger proportion of persistent patients (RR 0.54, 95% CI 0.40-0.72). No significant effects were observed on VTE, clinically relevant non-major bleeding (CNRMB), or mortality.

Behavioral interventions showed positive effects on adherence (SMD 0.24, 95%CI 0.02-0.46) and the proportion of persistent patients (RR 0.54, 95%CI 0.40-0.72), but did not significantly affect TTR or clinical outcomes.

Substantial heterogeneity in the ‘other’ intervention category precluded a comprehensive meta-analysis.

Conclusion(s): Educational interventions may improve TTR and anticoagulation intake, while behavioral interventions may improve anticoagulation intake. The impact on clinical outcomes remains unclear.