Cor Vasa 2026, 68(2):143-149 | DOI: 10.33678/cor.2025.094

Study of the Effect of Telecommunication Follow-Up for Patients on Warfarin During the COVID-19 Pandemic

Mohamed A. Abdelwahab^a, Karim Kamal^b, Mohamed El-Ramly^a, Kareem Mahmoud^a

^a Department of Cardiovascular Medicine, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt

^b Sohag Heart and GIT Specialized Center, Sohag, Egypt

Background: Warfarin, a vitamin K antagonist oral anticoagulant, requires frequent monitoring of the international normalized ratio (INR). Telemedicine has emerged as a crucial tool for facilitating remote health- care access, particularly during the COVID-19 pandemic. However, the efficacy and safety of this model for managing warfarin patients in Egypt remain unexplored.

Aim: This study compared telemedicine with conventional warfarin clinic visits regarding achieving target INR and time in therapeutic range (TTR), while assessing differences in expenses and complications.

Methods: Patients receiving warfarin at two tertiary centers in Egypt were randomized into telemedicine or conventional clinic groups. Telemedicine communication utilized telephone and WhatsApp. INR, TTR, cost analysis, and complications were evaluated.

Results: This three-month study included 200 patients. No significant baseline differences existed between groups except for higher smoking rates in the clinic group (40% vs. 24%, p = 0.02). Target TTR (> 70%) was achieved in 78% of clinic patients and 82% of telemedicine patients (p = 0.48). Among patients with baseline INR < 2, target TTR achievement was significantly higher in the telemedicine group (76.5% vs. 30.8%, p < 0.001). Supratherapeutic INR incidence was higher in the clinic group (40% vs. 20%, p = 0.002). No significant differences in bleeding or thrombotic events occurred between groups. Telemedicine services demonstrated significantly lower costs than conventional clinics.

Conclusion: Telecommunication offers a feasible alternative for warfarin management with comparable efficacy and safety in both urban and rural areas. This method significantly reduces cost burden on healthcare facilities and patients. We recommend adopting standardized telecommunication methods on a broader scale in Egyptian clinical practice.

Keywords: INR, Telemedicine, TTR, Warfarin,

Received: August 8, 2025; Revised: August 8, 2025; Accepted: September 1, 2025; Prepublished online: June 2, 2012; Published: May 20, 2026  Show citation