Warfarin in non-valvular atrial fibrillation

Dalby, Anthony J.; Wessels, Philippus L.; Opie, Lionel H.

doi:10.7196/samj.7172

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…During the study period, 21 of the 300 CoaguChek XS INR values (7.0%) would have been discrepant with standard laboratory INR measurements, resulting in different warfarin dosage adjustments according to the SA guidelines. [7,8]…”

Section: Clinical Utilitymentioning

confidence: 99%

Validation of the CoaguChek XS international normalised ratio point-of-care analyser in patients at Charlotte Maxeke Johannesburg Academic Hospital, South Africa

et al. 2016

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Section: Clinical Utilitymentioning

confidence: 99%

Validation of the CoaguChek XS international normalised ratio point-of-care analyser in patients at Charlotte Maxeke Johannesburg Academic Hospital, South Africa

et al. 2016

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“…Because generic warfarin is available at lower cost, warfarin and other VKAs are likely to remain the standard of care in the region. 71 Notably, however, as prosperity in Africa (measured as the proportion of the population living above the poverty line) increases, 72 the African middle class may find the convenience of NOACs, with their reduced burden of monitoring and fewer food–drug interactions, preferable to warfarin irrespective of their drug-related costs.…”

Section: Burden Of Af and Strokementioning

confidence: 99%

Atrial fibrillation in Sub-Saharan Africa: epidemiology, unmet needs, and treatment options

Stambler¹,

Ngunga²

2015

IJGM

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Health care in Sub-Saharan Africa is being challenged by a double burden of disease as lifestyle diseases common in the developed world, such as stroke and atrial fibrillation (AF), increase, while, simultaneously, health issues of the developing world in terms of communicable disease persist. The prevalence of AF is lower in Africa than in the developed world but is expected to increase significantly over the next few decades. Patients with AF in Africa tend to be younger and have a higher prevalence of rheumatic valvular heart disease than patients with AF in other regions. Permanent AF is the most prevalent type of AF in Africa, possibly due to the lower use of rhythm control strategies than in the developed world. Mortality rates of patients with AF in Africa are high, due largely to poor health care access and suboptimal therapy. The risk of stroke in AF, which is moderate to high in Africans as in the developed world, contributes to the high mortality rate. Patients with AF in Africa are often undertreated with antithrombotics, as cost and access to monitoring are major barriers. Vitamin K antagonists, including warfarin, are the most commonly available oral anticoagulants, but regular monitoring can be challenging, especially for patients in remote areas. Several non-vitamin K antagonist oral anticoagulants (NOACs) have been approved for use in countries across Sub-Saharan Africa and have the potential to reduce stroke burden. The higher cost of newer agents may be offset by the reduced need for regular monitoring, fixed dosing, and lower risk of intracranial bleeding; NOACs could provide a treatment option for patients in remote areas with limited access to regular monitoring. However, NOACs are not indicated in valvular AF. More work is needed to increase understanding of the epidemiology of AF and stroke, as well as to improve management strategies to reduce the burden of cardiovascular disease predicted for Africa.

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“…Available oral anticoagulants include the Vitamin K antagonists (VKAs) such as warfarin, and the newer/novel oral anticoagulants (NOACs) such as dabigatran. 6 , 7 , 8…”

Section: Introductionmentioning

confidence: 99%

Profile and anticoagulation outcomes of patients on warfarin therapy in an urban hospital in Cape Town, South Africa

Sonuga

Hellenberg

Cupido

et al. 2016

Afr. j. prim. health care fam. med.

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BackgroundWarfarin is the most frequently used oral anticoagulant worldwide and it is the oral anticoagulant of choice in South Africa for reducing thrombosis-related morbidity and mortality. However, the safety and efficacy of warfarin therapy depends mainly on careful monitoring and maintenance of the international normalised ratio (INR) within an optimal therapeutic range.AimThe aim of this study was to describe the profile and the anticoagulation outcomes of patients on warfarin therapy in a major warfarin clinic in the Western Cape Province of South Africa.SettingVictoria Hospital - a district hospital in Cape Town.MethodsA cross sectional review of clinical records of patients on warfarin therapy who attended the INR clinic from 01 January 2014 to 30 June 2014 was done. Data analysis was done with STATA to generate appropriate descriptive data.ResultsOur study showed that atrial fibrillation (AF) was the commonest indication for warfarin use in this study and hypertension was the commonest comorbidity among these patients. Only 48.5% achieved target therapeutic range; 51.5% were out-of-range. There was a significant association between alcohol consumption and poor anticoagulation outcomes (p-value < 0.022). Anticoagulation outcomes were better among the older age groups, male patients and in those with AF. The prevalence of thrombotic events while on warfarin treatment was 2.2%, while prevalence of haemorrhagic events was 14%. Most of the patients with bleeding events were on concurrent use of warfarin and other medications with potential drug interactions.ConclusionIn our study, patients who achieved target therapeutic control were less than the acceptable 60%.

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Warfarin in non-valvular atrial fibrillation

Cited by 5 publications

References 24 publications

Validation of the CoaguChek XS international normalised ratio point-of-care analyser in patients at Charlotte Maxeke Johannesburg Academic Hospital, South Africa

Validation of the CoaguChek XS international normalised ratio point-of-care analyser in patients at Charlotte Maxeke Johannesburg Academic Hospital, South Africa

Atrial fibrillation in Sub-Saharan Africa: epidemiology, unmet needs, and treatment options

Profile and anticoagulation outcomes of patients on warfarin therapy in an urban hospital in Cape Town, South Africa

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