Background Pharmaceutical firms are striving to find potential treatments to prevent and treat COVID-19. One of the gold standards to evaluate treatment is a clinical trial; however, the difficulty in patient recruitment could act as a determinant. It is evident from the registry data that very few studies have been conducted involving the population of the Middle East and North Africa (MENA) region. Aim To document knowledge, perception, and attitude of the public from Two large countries in the MENA region (Egypt and Saudi Arabia) towards participation in clinical trials focused on evaluating potential COVID-19 treatments. Method A cross-sectional study was conducted that used a snowball sampling strategy for recruitment. General population 18 years old or older, who lived in Saudi Arabia or Egypt were invited. The survey was adopted from literature and was approved by an ethics committee. Results Out of 800 participants in the survey, 407 participants were from Egypt, and 393 were from Saudi Arabia. Most participants (48%) had moderate knowledge, i.e., > 60% < 80%. The results revealed poor attitude (88.5%) and poor perceptions (45.8%) regarding participation in COVID-19 clinical trials. Education and residence were identified as determinants of participants’ knowledge, attitude, and perceptions. Participants' knowledge and understanding of COVID-19 trials did not impact their willingness to participate. This coupled with a poor attitude and perception among the masses drastically affects any potential for participation in future clinical trials. Conclusion: A relatively small proportion of participants were interested in enrolling in COVID-19 studies. Increased collective engagement through social media and healthcare professionals can help improve attitudes and perceptions toward trial participation.

Introduction: Atrial fibrillation is an irregular and can be a very rapid heart rate disorder. It is a type of arrhythmia that increases the risk of stroke and associated with increasing the risk of heart failure and all-cause mortality. Warfarin has been commonly prescribed in the treatment and prevention of different thromboembolic conditions including the atrial fibrillation. However, in recent years, several new oral anticoagulant medications with a direct and reversible inhibitory effect on the enzymatic activity of thrombin (dabigatran) or factor Xa (apixaban and rivaroxaban) in the coagulation cascade have been developed and approved by the FDA as an equivalent to warfarin or even more effective. We are doing this study to show the prevalence of those three drugs compared to warfarin and to estimate the patient's eligibility for using warfarin compared to the new oral anticoagulants. Method: Retrospective study, at Cardiology department at King Abdullah Medical city (KAMC) in Makkah. Result: We screened a total of 267 patients, out of 144 patients who were taking DOACs, 97 (74.6%) were included. And out of 123 patients who were taking warfarin, 33 (25.4%) of them were included. Patients were excluded because they don't have the right diagnosis, or do not have INR or serum creatinine results. Pregnant and lactating women were also excluded. Conclusion: Since FDA approval, apixaban and dabigatran use in AF has increased dramatically compared to warfarin which was diminished. In patients with AF, risks of stroke/SE and major bleeding were lower with DOACs versus warfarin. However, it is vital to perform continuous monitoring of these medication effectiveness.

Background: Factor X inhibition can cause the prolongation of PT by acting on the common pathway factors. Although, Expensive and less available “calibrated anti-FXa” predicts DOAC plasma level had better than prothrombin time (PT) and the international normalized ratio (INR). Consecutive reports raise more attention to (PT/INR) abnormalities in clinical scenarios for the minority of patients on DOACs. This study focuses on studying the magnitude of the Apixaban effect on INR elevation, which may be of clinical significance. Methods: This was a single-center, retrospective, observational analysis of adult patients who received at least 30 days of Apixaban. This study's primary outcome is to test the association between Apixaban use and significant INR elevation Results: Five hundred Fifty-two patients have screened in the study .194 patients meet our study aim criteria, Apixaban use was associated with a significant rise in INR levels after Apixaban (1.54 ± 2.59) compared to the previous values (1.03 ± 0.62) P <0.001. The mean rise was 0.58 (95% CI: 0.34-0.82, p<0.001). Multiple linear regression showed insignificance of all other tested variables, like Age, Polypharmacy, Use of CYP inhibitors, baseline INR, or renal function. Conclusion: Apixaban use is associated with a significant increase in INR in non-hospitalized patients, although the clinical outcomes of this observation are still understudied. Although routine monitoring of INR for Apixaban is generally unadvised, it is pivotal for practitioners to understand the magnitude of this phenomenon, more research is warranted to describe the clinical importance and guidance for those coagulation assays in daily practice.