Key result
Warfarin carries ~15% bleeding prevalence in Ethiopian adults, driven by aspirin use and comorbidities.
Why the study?
Warfarin has a narrow therapeutic index and is associated with clinically important bleeding complications, prompting this estimation of the prevalence and factors associated with bleeding among adult patients receiving warfarin in Ethiopia.
Meta-Analysis (n=2,873)
Yes
Approximately 15% of adult patients receiving warfarin in Ethiopia experience bleeding complications, with concomitant aspirin use and comorbid diseases serving as strong independent predictors requiring close INR monitoring and dose adjustment.
Answers are grounded in this paper and cite their sources.
Warrants caution with aspirin co-use and comorbidities in Ethiopian warfarin patients; extends bleeding risk data but leaves open prospective validation.
Background Warfarin is widely used for the prevention and treatment of thromboembolic conditions but has a narrow therapeutic index and is associated with clinically important bleeding complications. Objective To estimate the prevalence and factors associated with bleeding among adult patients receiving warfarin in Ethiopia. Methods A comprehensive literature search was conducted using major electronic databases, including PubMed, MEDLINE, EMBASE, ScienceDirect, Web of Science, and Google Scholar, to identify relevant studies published in English up to January 2025. Reviews, qualitative studies, case reports, grey literature, and studies with inaccessible full text were excluded from the study. Relevant original studies published and reported on the prevalence of bleeding (major and minor bleeding) among adult patients receiving warfarin. The retrieved articles were imported into EndNote X8 software to facilitate reference management and remove duplicate records. Data were extracted using a Microsoft Excel template and exported to STATA version 17.0 for analysis. Heterogeneity among the included studies was assessed using Higgins’ I² statistic test. A random-effects model was applied to estimate the pooled prevalence and factors associated with bleeding among adult patients receiving warfarin in Ethiopia. Results Eleven research articles were included in the final analysis. The studies included an evaluation of 2873 patients who were receiving warfarin. This systematic review and meta-analysis indicated that the pooled prevalence of bleeding among patients receiving warfarin was 15.11% (95% CI: 11.13, 19.10). Comorbid diseases (Pooled odds ratio (POR) = 3.20, 95%CI: 1.73, 5.89) and aspirin use (POR = 5.88, 95%CI: 2.25, 15.32) were independent predictors of bleeding among patients receiving warfarin. Conclusion This study finding revealed that the pooled prevalence of bleeding among adult patients receiving warfarin in Ethiopia was approximately 15%. Aspirin use and comorbid diseases were the independent predictors of bleeding among adult patients taking warfarin. This finding provides information for healthcare professionals and policymakers on prevention and appropriate use of warfarin to prevent warfarin-related bleeding. It highlights the need for close monitoring of patients on warfarin therapy, including regular international normalized ratio checks, careful dose adjustments among patients with comorbid diseases and concurrent medications. Clinical trial number Not applicable.
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Ararame et al. (2026) conducted a meta-analysis in Thromboembolic conditions treated with warfarin (n=2,873). Warfarin therapy was evaluated on Pooled prevalence of bleeding (major and/or minor bleeding) (Prevalence 15.11%, 95% CI 11.13-19.10, p=0.000). Warfarin therapy in Ethiopian adults had a pooled bleeding prevalence of 15.11%, predicted by aspirin use and comorbid diseases.
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