Warfarin anticoagulation control was poor in 85.1% of patients, with a median time in therapeutic range of 30.8%, and hypertension predicted poor control (adjusted OR 2.24; 95% CI 1.02-4.94).
Cross-Sectional (n=410)
No
What is the quality of anticoagulation and what are the predictors of poor control among patients on warfarin in Botswana?
The quality of warfarin anticoagulation in this Botswana cohort was poor, with a median TTR of 30.8% and 85.1% of patients having suboptimal control, highlighting a critical need for improved monitoring strategies.
Effect estimate: adjusted OR 2.24 (95% CI 1.02-4.94)
Warfarin treatment requires regular and proper monitoring to avoid overanticoagulation and at the same time to prevent thromboembolic complications. This study assessed the quality of warfarin anticoagulation at Princess Marina Hospital in Botswana. This cross-sectional study consecutively enrolled patients who were on warfarin for at least 3 months in the outpatient medical clinic. The level of anticoagulation was determined by the time in therapeutic range (TTR) using the Rosendaal method that calculates the percentage of days when the international normalized ratio is in the therapeutic range (2.0-3.0). Poor anticoagulation control was defined as an estimated TTR <65%. We performed univariate and multivariate logistic regression to assess predictors of poor anticoagulation control. Of total, 410 (68.8% women) patients whose median age was 46 (interquartile range IQR, 35-58) years were enrolled. Indications for warfarin included mechanical heart valves, 185 (45.1%); deep vein thrombosis, 114 (26.8%); and atrial fibrillation, 68 (17.8%). Of the 2004 tests (an average of 4.9 tests per patient) assessed, only 20% of the tests were within the therapeutic range. The median TTR was 30.8% (IQR, 15.2-52.7). Most (85.1%) patients had poor anticoagulation control. Cigarette smoking and pulmonary hypertension perfectly predicted poor anticoagulation. Hypertension was a predictor of poor anticoagulation control (adjusted odds ratio = 2.24; 95% confidence interval: 1.02-4.94). The quality of anticoagulant therapy with warfarin in Botswana patients is poor. The evidence calls for efforts to improve the level of anticoagulation control among patients on warfarin in Botswana.
Mwita et al. (Tue,) conducted a cross-sectional in Patients requiring anticoagulation (n=410). Warfarin was evaluated on Poor anticoagulation control (estimated time in therapeutic range <65%) (adjusted OR 2.24, 95% CI 1.02-4.94). Warfarin anticoagulation control was poor in 85.1% of patients, with a median time in therapeutic range of 30.8%, and hypertension predicted poor control (adjusted OR 2.24; 95% CI 1.02-4.94).