Web-Based Warfarin Management (Alfalfa App) Versus TraditionalWarfarin Management:Multicenter Prospective Cohort Study

Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and evendeath due to anticoagulation-related adverse events. Traditional non-web-based outpatient clinics struggle to provide idealanticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenientmode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse eventsbetween a web-based management model (via a smartphone app) and the conventional non-web-based outpatient managementmodel. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteriawere split into a web-based management group using the Alfalfa app or a non-web-based management group with traditionaloutpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results andclinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time intherapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and thedistribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99%) patientsreaching the follow-up end point, including 260 (50%) in the non-web-based management group and 259 (50%) in the web-basedmanagement group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-basedmanagement group had a significantly higher TTR than the non-web-based management group (82.4% vs 71.6%, P<.001), anda higher proportion of patients received effective anticoagulation management (81.2% vs 63.5%, P<.001). The incidence of minorbleeding events in the non-web-based management group was significantly higher than that in the web-based management group(12.1% vs 6.6%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleedingand thromboembolic and all-cause death events. In addition, compared with the non-web-based management group, the web-basedmanagement group had a lower proportion of INR in the extreme subtreatment range (17.6% vs 21.3%) and severe supertreatmentrange (0% vs 0.8%) and a higher proportion in the treatment range (50.4% vs 43.1%), with statistical significance. Conclusions: Compared with traditional non-web-based outpatient management, web-based management via the Alfalfa appmay be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleedingevents, and improve INR distribution.