Using Artificial Intelligence to Reduce the Risk of Nonadherence in Patients on Anticoagulation Therapy.
Using Artificial Intelligence to Reduce the Risk of Nonadherence in Patients on Anticoagulation Therapy.
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DOI：
10.1161/strokeaha.116.016281
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发表时间：
2017-05
期刊：
影响因子：
8.3
通讯作者：
Hanina A
中科院分区：
文献类型：
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作者：
Labovitz DL;Shafner L;Reyes Gil M;Virmani D;Hanina A
本研究评价了在移动的设备上使用人工智能（AI）平台测量和增加接受抗凝治疗的卒中患者的药物依从性。直接口服抗凝剂（DOAC）的引入，在减少监测需求的同时，也给患者带来了自我管理的压力。由于常规实验室检查不是依从性的可靠指标，因此未检测到次优依从性，从而使患者中风和出血的风险增加。在近期诊断为缺血性卒中并接受任何抗凝治疗的成人（n = 28）中进行了一项随机、平行组、12周研究。患者被随机分配至通过AI平台进行每日监测（干预）或不进行每日监测（对照）。人工智能应用程序可以直观地识别患者、药物和确认的摄入。通过两组的药丸计数和血浆采样来测量依从性。所有患者（n = 28）的平均（标准差[SD]）年龄为57（13.2）岁，53.6%为女性。基于AI平台的平均（SD）累积依从性为90.5%（7.5%）。血浆药物浓度水平表明，干预组和对照组的依从性分别为100%（15/15）和50%（6/12）。患者，一些几乎没有使用智能手机的经验，成功地使用了该技术，并证明了基于血浆药物浓度水平的依从性提高了50%。对于接受DOAC的患者，绝对改善增加至67%。实时监测有可能增加依从性和改变行为，特别是在DOAC治疗的患者中。临床试验注册-URL：http://www.clinicaltrials.gov。唯一标识符：NCT 02599259。
This study evaluated the use of an artificial intelligence (AI) platform on mobile devices in measuring and increasing medication adherence in stroke patients on anticoagulation therapy. The introduction of direct oral anticoagulants (DOACs), while reducing the need for monitoring, have also placed pressure on patients to self-manage. Suboptimal adherence goes undetected as routine laboratory tests are not reliable indicators of adherence, placing patients at increased risk of stroke and bleeding. A randomized, parallel-group, 12-week study was conducted in adults (n = 28) with recently diagnosed ischemic stroke receiving any anticoagulation. Patients were randomized to daily monitoring by the AI Platform (intervention) or to no daily monitoring (control). The AI application visually identified the patient, the medication and confirmed ingestion. Adherence was measured by pill counts and plasma sampling in both groups. For all patients (n = 28), mean (standard deviation [SD]) age was 57 (13.2) years and 53.6% were female. Mean (SD) cumulative adherence based on the AI Platform was 90.5% (7.5%). Plasma drug concentration levels indicated that adherence was 100% (15 of 15) and 50% (6 of 12) in the intervention and control groups, respectively. Patients, some with little experience using a smartphone, successfully used the technology and demonstrated a 50% improvement in adherence based on plasma drug concentration levels. For patients receiving DOACs, absolute improvement increased to 67%. Real-time monitoring has the potential to increase adherence and change behavior, particularly in patients on DOAC therapy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02599259.