{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T02:39:20Z","timestamp":1788143960637,"version":"build-2803163510"},"reference-count":40,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Mhealth Uhealth"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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\u2019s feasibility on user satisfaction and demand.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n 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\n P<\/jats:italic>\n value of \u2264.05 was considered statistically significant.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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%,\n P<\/jats:italic>\n <.001). Participants in the Alfalfa app group had a higher monitoring frequency (8.14 vs 4.47,\n P<\/jats:italic>\n <.001) and a greater percentage of international normalized ratio values within the target range (896\/1660, 53.98% vs 346\/899, 38.49%;\n P<\/jats:italic>\n <.001) than those in the offline group. In addition, the Alfalfa app group exhibited lower rates of subtherapeutic (235\/1660, 14.16% vs 152\/899, 16.91%;\n P<\/jats:italic>\n <.05) and extreme subtherapeutic international normalized ratio values (273\/1660, 16.45% vs 186\/899, 20.69%;\n P<\/jats:italic>\n <.05) than the offline group. However, the incidence of minor bleeding was higher in the Alfalfa app group (12\/204, 5.9% vs 3\/201, 1.5%;\n P<\/jats:italic>\n =.02). In terms of cost-effectiveness, the Alfalfa app group had a significantly lower average cost per test (42.37 vs 78.3,\n P<\/jats:italic>\n <.001), average time per test (47.42 vs 90.74,\n P<\/jats:italic>\n <.001), and cost-effectiveness ratio (385.9 vs 662.9) than the offline group. A total of 86 participants completed the satisfaction questionnaire, and the vast majority of participants expressed high levels of satisfaction with the Alfalfa App, while also providing further suggestions for improvement.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The integration of \u201cInternet+Pharmacy Care\u201d using the Alfalfa App can improve the effectiveness of warfarin anticoagulation management in patients following heart valve surgery. The Alfalfa app provides a more efficient, secure, and cost-effective solution to warfarin management than traditional offline methods.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/53586","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T22:54:34Z","timestamp":1743029674000},"page":"e53586-e53586","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy, Safety, and Cost-Effectiveness of \u201cInternet + Pharmacy Care\u201d Via the Alfalfa App in Warfarin Therapy Management After Cardiac Valve Replacement: Randomized Controlled 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