4. Discussion
ADVERSE EVENTS
The results of our SMART trial indicate that social app care was associated with a reduced incidence of major bleedings during an average 491 days of follow-up. The anticoagulation quality, including TTR, INR variation, and time periods of extremely high INR, also significantly improved with social app care compared with routine care in post-MHVR patients receiving long-term warfarin therapy.In the current study, social app care worked like a “real-time online anticoagulation clinic”. With the help of the social app, the warfarin treatments were not limited to long distances, which lowered traffic inconvenience and time costs to ensure a high frequency of monitoring and timely dose adjustments. Since the use of a social app removed barriers of communication between doctors and patients, the miniprogramme promoted the use of self-testing and has also been reported to be effective in improving warfarin control [Previously, various efforts have been made to improve warfarin anticoagulation in China, including through pharmacist clinics and anticoagulant clinics [The higher the TTR, the fewer the adverse events that occur. We observed a significant reduction in the number of major bleedings as the TTR increased, which was consistent with the results of the previous studies [This study has several limitations. First, this study was a single-centre study, and selection bias may exist. Although we attempted to enrol all eligible subjects, 51 patients were excluded. In addition, the TTR of the control group was higher than that reported in previous literature [