Efficacy, Safety, and Cost-Effectiveness of “Internet + Pharmacy Care” Via the Alfalfa App in Warfarin Therapy Management After Cardiac Valve Replacement: Randomized Controlled Trial

Abstract

Background: Anticoagulation management is important in preventing complications in patients undergoing cardiac valve replacement. The development of mobile apps offers new opportunities for the management of long-term anticoagulants. However, there is a lack of randomized controlled trials evaluating the effectiveness, safety, cost-effectiveness, and user demand for internet-based anticoagulation management. Objective: This study aimed to evaluate the efficacy, safety, and cost-effectiveness of a 3-month warfarin dose adjustment mobile app Alfalfa compared to offline management in patients postcardiac valve replacement. We also explored the app’s feasibility on user satisfaction and demand. Methods: This study was a randomized controlled trial with assessments conducted at baseline and at a 3-month follow-up. Participants were eligible if they had been on warfarin therapy for at least 3 months, received warfarin management either through the Alfalfa app or through pharmacist-led anticoagulation outpatient clinic visits, consented to regular follow-ups, and had not experienced serious bleeding or thrombotic events in the 3 months before warfarin treatment. A P value of ≤.05 was considered statistically significant. Results: A total of 405 participants were included in the analysis. The time in therapeutic range was significantly higher in the Alfalfa app group than in the offline group (66.46% vs 46.65%, P