{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:52:33Z","timestamp":1782845553459,"version":"3.54.5"},"reference-count":25,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"\n Background<\/jats:title>\n Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non\u2013web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non\u2013web-based outpatient management model.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non\u2013web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99%) patients reaching the follow-up end point, including 260 (50%) in the non\u2013web-based management group and 259 (50%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non\u2013web-based management group (82.4% vs 71.6%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2% vs 63.5%, P<.001). The incidence of minor bleeding events in the non\u2013web-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 bleeding and thromboembolic and all-cause death events. In addition, compared with the non\u2013web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6% vs 21.3%) and severe supertreatment range (0% vs 0.8%) and a higher proportion in the treatment range (50.4% vs 43.1%), with statistical significance.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Compared with traditional non\u2013web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/46319","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T11:30:51Z","timestamp":1722252651000},"page":"e46319","source":"Crossref","is-referenced-by-count":0,"title":["Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study"],"prefix":"10.2196","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8224-0882","authenticated-orcid":false,"given":"Wenfei","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5779-1972","authenticated-orcid":false,"given":"Jiana","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6722-0978","authenticated-orcid":false,"given":"Shaojun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4490-0380","authenticated-orcid":false,"given":"Chunhua","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5629-0348","authenticated-orcid":false,"given":"Jinhua","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.05.044"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s00059-017-4643-5"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2196\/23332"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-020-00474-3"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.115.011833"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k3532"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-031730"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2021.151521"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2161"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000233981.26176.e1"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003489"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1177\/1747493016658300"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01204.x"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2017.07.016"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.114.008578"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-020-00961-0"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.677943"},{"key":"ref19","unstructured":"GuMStudy of telemedicine application for warfarin anticoagulation management in atrial fibrillation. ThesisYangzhou University20192022-03-03https:\/\/authserver-443.webvpn.fjmu.edu.cn\/authserver\/login?service=https%3A%2F%2Fwebvpn.fjmu.edu.cn%2Fusers%2Fauth%2Fcas%2Fcallback%3Furl"},{"issue":"04","key":"ref20","first-page":"343","volume":"26","author":"Li, JZ","year":"2019","journal-title":"Chinese Journal of Clinical Thoracic and Cardiovascular Surgery"},{"key":"ref21","first-page":"447","author":"Baksheev, A","year":"2020","journal-title":"Revista Inclusiones"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.2196\/18426"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.116.025250"},{"key":"ref24","unstructured":"The 48th statistical report on the development of the Internet in ChinaChina Internet Information Center20212022-03-01http:\/\/www.bjjubao.org.cn\/2021-09\/26\/content_43536.html"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1111\/jcc4.12154"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2024\/1\/e46319","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:52:44Z","timestamp":1782841964000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2024\/1\/e46319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,29]]},"references-count":25,"URL":"https:\/\/doi.org\/10.2196\/46319","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.46319","asserted-by":"object"}]},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,29]]}}}