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Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa.
Mwita, Julius Chacha; Francis, Joel Msafiri; Pillay, Chriselda; Ogah, Okechukwu S; Goshu, Dejuma Yadeta; Agyekum, Francis; Musonda, John Mukuka; James, Maduka Chiedozie; Tefera, Endale; Kabo, Tsie; Ditlhabolo, Keolebile Irene; Ndlovu, Kagiso; Ayodele, Ayoola Yekeen; Mikomangwa, Wigilya P; Chillo, Pilly; Damasceno, Albertino; Folson, Aba Ankomaba; Oyekunle, Anthony; Tebuka, Erius; Kalokola, Fredrick; Forrest, Karen; Dunn, Helena; Karaye, Kamilu; Jean-Pierre, Fina Lubaki; Oljira, Chala Fekadu; Assefa, Tamrat; Taiwo, Tolulope Shogade; Nwafor, Chibuike E; Omole, Olufemi; Anakwue, Raphael; Cohen, Karen.
Afiliação
  • Mwita JC; Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana. mwitajc@ub.ac.bw.
  • Francis JM; Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Pillay C; Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
  • Ogah OS; Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria.
  • Goshu DY; Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Agyekum F; Department of Medicine, College of Health Sciences, Korlebu Teaching Hospital, University of Ghana, Ghana, Ethiopia.
  • Musonda JM; Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • James MC; Federal Medical Centre (FMC), Umuahia, Abia State, Nigeria.
  • Tefera E; Department of Paediatrics and Adolescent Health, University of Botswana and Princess Marina Hospital, Gaborone, Botswana.
  • Kabo T; Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana.
  • Ditlhabolo KI; Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Ndlovu K; Department of Computer Science, University of Botswana, Gaborone, Botswana.
  • Ayodele AY; Cardiology Unit, Department of Medicine, Federal Teaching Hospital, Gombe, Gombe State, Nigeria.
  • Mikomangwa WP; Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Chillo P; Department of Internal Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
  • Damasceno A; Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.
  • Folson AA; University of Health and Allied Sciences, Accra, Ghana.
  • Oyekunle A; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
  • Tebuka E; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
  • Kalokola F; Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
  • Forrest K; MRC Unit The Gambia at LSHTM, Fajara, The Gambia.
  • Dunn H; MRC Unit The Gambia at LSHTM, Fajara, The Gambia.
  • Karaye K; Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria.
  • Jean-Pierre FL; Department of Family Medicine and Primary Care, The Protestant University of Congo, Kinshasa, Democratic Republic of the Congo.
  • Oljira CF; Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Assefa T; Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Taiwo TS; University of Uyo Teaching Hospital, Uyo, Nigeria.
  • Nwafor CE; The University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
  • Omole O; Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Anakwue R; Departments of Medicine, Pharmacology/Therapeutics, The University of Nigeria Teaching Hospital, Enugu, Nigeria.
  • Cohen K; Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
J Thromb Thrombolysis ; 57(4): 613-621, 2024 Apr.
Article em En | MEDLINE | ID: mdl-38478250
ABSTRACT
Vitamin K antagonists (VKA) is the primary anticoagulant in most settings of Sub-Saharan Africa. Understanding the quality of anticoagulation services in the continent is vital in optimising the intended benefits. This study assessed the quality of anticoagulation and associated factors among VKA-treated patients in nine SSA countries. We conducted a retrospective cohort study of randomly selected patients on anticoagulation from 20 clinics in Botswana, the Democratic Republic of Congo, Ethiopia, Gambia, Ghana, Mozambique, Nigeria, Tanzania, and South Africa. Eligible participants were those on VKAs for at least three months and with at least four international normalised ratios (INR) results in 2019-2021. We report the proportion of INR values in the therapeutic range, time-in-therapeutic range (TTR) using the Rosendaal method, and the proportion of patients with TTR ≥ 65% (optimal anticoagulation). The mean age was 51.1(16.1) years, and 64.2% were women. The most common indications for VKA included venous thromboembolism (29.6%), prosthetic valves (26.7%) and atrial fibrillation/flutter (30.1%). We analysed 6743 INR tests from 1011 participants, and of these, 48.5% were sub-therapeutic, 34.1% therapeutic, and 17.4% were supratherapeutic relative to disease-specific reference ranges. TTR was calculated for 660 patients using 4927 INR measurements. The median (interquartile range [IQR]) TTR was 35.8(15.9,57.2) %. Optimal anticoagulation control was evident in 19.2% of participants, varying from 2.7% in Tanzania to 23.1% in Ethiopia. The proportion of patients with TTR ≥ 65% was 15,4% for prosthetic heart valves, 21.1% for venous thromboembolism and 23.7% for atrial fibrillation or flutter. Countries with universal health coverage had higher odds of optimal anticoagulation control (adjusted odds ratio (aOR) 1.79, 95% confidence interval [CI], 1.15- 2.81, p = 0.01). Patients on VKAs for different therapeutic indications in SSA had suboptimal TTR. Universal health coverage increased the odds of achieving TTR by 79%. The evidence calls for more intensive warfarin management strategies in SSA, including providing VKA services without out-of-pocket payments.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Tromboembolia Venosa Limite: Female / Humans / Male / Middle aged País/Região como assunto: Africa Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Tromboembolia Venosa Limite: Female / Humans / Male / Middle aged País/Região como assunto: Africa Idioma: En Ano de publicação: 2024 Tipo de documento: Article