Why the study?
Patients in sub-Saharan Africa generally have poor anticoagulation control, prompting a review of potential reasons and solutions.
Locally-developed 'warfarin care bundles' may be the most appropriate solution to overcome the multiple challenges of poor anticoagulation control in sub-Saharan Africa.
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Locally-developed warfarin care bundles merit pilot evaluation in sub-Saharan Africa; hypothesis-generating and requires prospective trials before practice change.
Patients in sub-Saharan Africa generally have poor anticoagulation control. We review the potential reasons for this poor control, as well as the potential solutions. Challenges include the affordability and centralisation of anticoagulation care, problems with access to medicines and INR monitoring, the lack of locally-validated standardized dosing protocols, and low levels of anticoagulation knowledge among health care workers and patients. Increasing numbers of patients will need anticoagulation in the future because of the epidemiological transition in the region. We propose that locally-developed “warfarin care bundles” which address multiple anticoagulation challenges in combination may be the most appropriate solution in this setting currently.
Mouton et al. (2020) studied this question.