Warfarin: time in therapeutic range, a single centre study on patients using warfarin for stroke prevention in non-valvular atrial fibrillation and prosthetic heart valves

Sadhabiriss, D.

doi:10.24170/18-1-4771

Cited by 2 publications

(4 citation statements)

References 27 publications

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“…The lowest percentage of TTR was 13.7% (mean) which was reported by a study conducted in adult patients with prosthetic heart valves at the medical outpatient department in KwaZulu-Natal, South Africa [ 33 ]. However, a mean TTR of 44.5% was reported in this South African study among AF patients.…”

Section: Resultsmentioning

confidence: 98%

“…Pre-post intervention [ 41 ] and prospective study designs [ 42 , 43 ] were employed by one and two studies, respectively. Five studies were conducted in South Africa [ 7 , 28 , 33 , 37 , 38 ], 3 in Ethiopia [ 23 , 31 , 40 ], 2 in Sudan [ 32 , 41 ], 2 in Kenya [ 36 , 42 ], 2 in Tunisia [ 29 , 43 ] and 2 in Botswana [ 39 , 44 ]. One study was included from Namibia [ 35 ] and the remaining one study was conducted both in South Africa and Uganda.…”

Section: Resultsmentioning

confidence: 99%

“…The direct method (the fraction of INRs in range) and the cross-section-of- the-files method were utilized by two studies [ 37 , 47 ]. In the remaining two studies [ 32 , 33 , 35 ], TTR was calculated both by direct and Roosendaal’s methods [ 32 , 35 ]. The included studies reported TTR as mean and /or median TTR percentages or only percentages.…”

Section: Resultsmentioning

confidence: 99%

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Anticoagulation control, outcomes, and associated factors in long-term-care patients receiving warfarin in Africa: a systematic review

et al. 2022

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Background Oral anticoagulation therapy with warfarin requires frequent monitoring level of anticoagulation by the international normalized ratio (INR). In Africa, studies that explore anticoagulation control, treatment outcomes, and associated factors are reported in various ways in long-term patients receiving warfarin therapy to generate concrete scientific evidence. Methods The literature search was conducted in PubMed, Cochrane Library, African Journal of Online databases, Google Scholar, and Google. An advanced search strategy was computed to retrieve relevant studies related to anticoagulation control and outcomes. Duplication, title and abstract screening, and full-text assessment were conducted in Covidence software. Study quality was assessed using the Joanna Briggs Institute Critical appraisal quality assessment tool. The systematic review is registered in PROSPERO (CRD42021260772) and performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. Results Out of 298 identified articles, 18 articles were eligible for the final review and analysis. The mean of 39.4 ± 8.4% time in therapeutic range (TTR) (29.4 to 57.3%), 36.7 ± 11.5% TTR (range 25.2–49.7%) and 46% TTR (43.5–48.5%) was computed from studies that determined TTR by Rosendaal, direct and cross-section-of-the-files methods, respectively. In this review, the lowest percentage of TTR was 13.7%, while the highest was 57.3%. The highest percentage of patients (32.25%) who had TTR ≥ 65% was reported in Tunisia, but the lowest percentages were in Namibia (10%, TTR ≥ 65%) and Kenya (10.4%, TTR ≥ 70%). Most of the included studies (11 out of 18) used Rosendaal’s method while the direct method was employed by three studies. Generally, 10.4–32.3% of study participants achieved desired optimal anticoagulation level. Regarding secondary outcomes, 1.6–7.5% and 0.006–59% of patients experienced thromboembolic complications and bleeding events, respectively. Having chronic comorbidities, taking more than two drugs, and presence of medications that potentially interact with warfarin, and patient-related factors (patients aged < 50 years old, female gender, lower education level, smoking history) were the frequently reported predictors of poor anticoagulation therapy. Conclusions Oral anticoagulation control was suboptimal in patients taking warfarin as evidenced by low TTR in Africa. Therefore, there is an urgent need for further improving oral anticoagulation management services.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Anticoagulation control, outcomes, and associated factors in long-term-care patients receiving warfarin in Africa: a systematic review

et al. 2022

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“…1,11,[15][16][17][18][19][20][21][22][23] The problem seems the worst in Africa, as the lowest TTRs were reported in different regions of the continent. 7,20,[24][25][26][27] Similarly, in Ethiopia, only four studies were conducted in government health facilities and reported lower TTRs in the range of 29-38%. [28][29][30][31] Despite the wide availability of warfarin as an oral anticoagulant, information on its level of anticoagulation control is scarce in Ethiopia, especially in private settings.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation Management in Patients Receiving Warfarin at Private Cardiac Centers in Addis Ababa, Ethiopia

Getachew¹,

Tadesse²,

Shashu³

et al. 2023

JBM

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Introduction Anticoagulants are the cornerstone therapy for thromboembolism prevention and treatment. Warfarin is the frequently prescribed drug and remains the oral anticoagulant of choice in low- and middle-income countries, including Ethiopia. It is a narrow therapeutic index drug that needs high-quality anticoagulation monitoring with frequent international normalization ratio (INR) testing. Objective The study aimed to assess anticoagulation management with warfarin among adult outpatients at two selected private cardiac centers in Addis Ababa, Ethiopia. Methods A hospital-based retrospective study design that enrolled 374 patients receiving warfarin was employed at two private cardiac centres in Addis Ababa, Ethiopia. The time in the therapeutic range (TTR) was calculated using the Rosendaal method. The data were analyzed using Statistical Package for Social Science version 25. Results The mean age of the patients was 57 years, and 218 (58.3%) participants were females. Out of 3384 INR tests, 1562 (46.5%) were within the therapeutic range and the mean percentage of TTR was 47.24%. Only 25.67% of the patients spent their TTR ≥ 65%. The present study revealed that dose adjustments were required 1764 times. In non-therapeutic INR values of 1764 that required warfarin dose adjustment, 59.7% of the doses were adjusted. About 262 (70.1%) of co-prescribed medications had interaction with warfarin. Sixty-four patients (17.11%) experienced bleeding events. Conclusion Anticoagulation management with warfarin was suboptimal in private cardiac Addis Ababa, Ethiopia, private cardiac centers. Warfarin adjustment practice for nontherapeutic INR values was not minimal, and many patients encountered bleeding during their course of therapy.

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Warfarin: time in therapeutic range, a single centre study on patients using warfarin for stroke prevention in non-valvular atrial fibrillation and prosthetic heart valves

Cited by 2 publications

References 27 publications

Anticoagulation control, outcomes, and associated factors in long-term-care patients receiving warfarin in Africa: a systematic review

Anticoagulation control, outcomes, and associated factors in long-term-care patients receiving warfarin in Africa: a systematic review

Anticoagulation Management in Patients Receiving Warfarin at Private Cardiac Centers in Addis Ababa, Ethiopia

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