Trial reportJMIR mHealth and uHealth2025
Efficacy, Safety, and Cost-Effectiveness of "Internet + Pharmacy Care" Via the Alfalfa App in Warfarin Therapy Management After Cardiac Valve Replacement: Randomized Controlled Trial.
Trial report in JMIR mHealth and uHealth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- The Effectiveness of Digital Therapeutics Intervention in Oral Anticoagulation Management: A Systematic Review and Meta-analysis.Mayo Clinic proceedings. Digital health · 2026Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
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<.001). Participants in the Alfalfa app group had a higher monitoring frequency (8.14 vs 4.47, P<.001) and a greater percentage of international normalized ratio values within the target range (896/1660, 53.98% vs 346/899, 38.49%; P<.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%; P<.05) and extreme subtherapeutic international normalized ratio values (273/1660, 16.45% vs 186/899, 20.69%; P<.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%; P=.02). In terms of cost-effectiveness, the Alfalfa app group had a significantly lower average cost per test (42.37 vs 78.3, P<.001), average time per test (47.42 vs 90.74, P<.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. Conclusions: The integration of "Internet+Pharmacy Care" 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.
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