Direct-acting oral anticoagulants are effective alternatives to warfarin, but their widespread adoption in sub-Saharan Africa is limited by high acquisition costs and a lack of local clinical trials.
Are direct oral anticoagulants a viable and safe alternative to warfarin for patients with thromboembolic disorders in sub-Saharan Africa?
While DOACs offer an effective alternative to warfarin, their adoption in sub-Saharan Africa requires overcoming cost barriers and conducting regional trials to ensure safety.
Warfarin has existed for >7 decades and has been the anticoagulant of choice for many thromboembolic disorders. The recent introduction of direct-acting oral anticoagulants (DOACs) has, however, caused a shift in preference by healthcare professionals all over the world. DOACs have been found to be at least as effective as warfarin in prevention of stroke in patients with atrial fibrillation and in treatment of venous thromboembolism. In sub-Saharan Africa, however, the widespread use of DOACs has been hampered mainly by their higher acquisition costs. As the drugs come off patent, their use in sub-Saharan Africa is likely to increase. However, very few trials have been conducted in African settings, and safety concerns will need to be addressed with further study before widespread adoption into clinical practice.
Semakula et al. (2021) conducted a review in Thromboembolic disorders. Direct-acting oral anticoagulants (DOACs) vs. Warfarin was evaluated. Direct-acting oral anticoagulants are effective alternatives to warfarin, but their widespread adoption in sub-Saharan Africa is limited by high acquisition costs and a lack of local clinical trials.