Improving Anticoagulation in Sub-Saharan Africa: What Are the Challenges and How Can We Overcome Them?

Overview

Journal Br J Clin Pharmacol

Specialty Pharmacology

Date 2021 Feb 15

PMID 33586223

Citations 9

Authors

Johannes P Mouton

Marc Blockman

Christine Sekaggya-Wiltshire

Jerome Semakula

Catriona Waitt

Munir Pirmohamed

Karen Cohen

Affiliations

Soon will be listed here.

Abstract

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 international normalised ratio monitoring, the lack of locally validated standardized dosing protocols, and low levels of anticoagulation knowledge among healthcare workers and patients. Increasing numbers of patients will need anticoagulation in the future because of the increasing burden of noncommunicable disease 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.

Citing Articles

Meta-analysis of genome-wide association studies of stable warfarin dose in patients of African ancestry.

Asiimwe I, Blockman M, Cavallari L, Cohen K, Cupido C, Dandara C Blood Adv. 2024; 8(20):5248-5261.

PMID: 39163621 PMC: 11493193. DOI: 10.1182/bloodadvances.2024014227.

A "Bundle of Care" to Improve Anticoagulation Control in Patients Receiving Warfarin in Uganda and South Africa: Protocol for an Implementation Study.

Jorgensen A, Orrell C, Waitt C, Toh C, Sekaggya-Wiltshire C, Hughes D JMIR Res Protoc. 2023; 12:e46710.

PMID: 37467034 PMC: 10398551. DOI: 10.2196/46710.

Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward.

Minja N, Nakagaayi D, Aliku T, Zhang W, Ssinabulya I, Nabaale J Front Cardiovasc Med. 2022; 9:1008335.

PMID: 36440012 PMC: 9686438. DOI: 10.3389/fcvm.2022.1008335.

A genome-wide association study of plasma concentrations of warfarin enantiomers and metabolites in sub-Saharan black-African patients.

Asiimwe I, Blockman M, Cohen K, Cupido C, Hutchinson C, Jacobson B Front Pharmacol. 2022; 13:967082.

PMID: 36210801 PMC: 9537548. DOI: 10.3389/fphar.2022.967082.

Anticoagulation control, outcomes, and associated factors in long-term-care patients receiving warfarin in Africa: a systematic review.

Tadesse T, Tegegne G, Yadeta D, Chelkaba L, Gedif Fenta T Thromb J. 2022; 20(1):58.

PMID: 36192776 PMC: 9528137. DOI: 10.1186/s12959-022-00416-9.

References

Cordier W, Steenkamp V . Herbal remedies affecting coagulation: a review. Pharm Biol. 2011; 50(4):443-52. DOI: 10.3109/13880209.2011.611145. View

Chang A, Nabbaale J, Nalubwama H, Okello E, Ssinabulya I, Longenecker C . Motivations of women in Uganda living with rheumatic heart disease: A mixed methods study of experiences in stigma, childbearing, anticoagulation, and contraception. PLoS One. 2018; 13(3):e0194030. PMC: 5874006. DOI: 10.1371/journal.pone.0194030. View

Rwebembera J, Manyilirah W, Zhu Z, Nabbaale J, Namuyonga J, Ssinabulya I . Prevalence and characteristics of primary left-sided valve disease in a cohort of 15,000 patients undergoing echocardiography studies in a tertiary hospital in Uganda. BMC Cardiovasc Disord. 2018; 18(1):82. PMC: 5935941. DOI: 10.1186/s12872-018-0813-5. View

Khuluza F, Haefele-Abah C . The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study. PLoS One. 2019; 14(2):e0212125. PMC: 6372227. DOI: 10.1371/journal.pone.0212125. View

Liwa A, Smart L, Frumkin A, Epstein H, Fitzgerald D, Peck R . Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review. Curr Hypertens Rep. 2014; 16(6):437. PMC: 4076776. DOI: 10.1007/s11906-014-0437-9. View

Bekele Daba F, Tadesse F, Engidawork E . Drug-related problems and potential contributing factors in the management of deep vein thrombosis. BMC Hematol. 2016; 16:2. PMC: 4743403. DOI: 10.1186/s12878-016-0043-y. View

Zuhlke L, Karthikeyan G, Engel M, Rangarajan S, Mackie P, Cupido-Katya Mauff B . Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study). Circulation. 2016; 134(19):1456-1466. DOI: 10.1161/CIRCULATIONAHA.116.024769. View

Semakula J, Mouton J, Jorgensen A, Hutchinson C, Allie S, Semakula L . A cross-sectional evaluation of five warfarin anticoagulation services in Uganda and South Africa. PLoS One. 2020; 15(1):e0227458. PMC: 6988943. DOI: 10.1371/journal.pone.0227458. View

Pastakia S, Fohl A, Schellhase E, Manji I, Ringenberg K . Needs assessment analysis for vitamin K antagonist anticoagulation in the resource-constrained setting of Eldoret, Kenya. J Am Pharm Assoc (2003). 2010; 50(6):723-5. DOI: 10.1331/JAPhA.2010.09226. View

10.

Tegene E, Tadesse I, Markos Y, Gobena T . Prevalence and risk factors for atrial fibrillation and its anticoagulant requirement in adults aged ≥40 in Jimma Town, Southwest Ethiopia: A community based cross-sectional study. Int J Cardiol Heart Vasc. 2019; 22:199-204. PMC: 6437289. DOI: 10.1016/j.ijcha.2019.02.003. View

11.

Kamuren Z, Kigen G, Keter A, Maritim A . Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings. BMC Health Serv Res. 2018; 18(1):723. PMC: 6145184. DOI: 10.1186/s12913-018-3537-4. View

12.

Rudd K, Dier J . Comparison of two different models of anticoagulation management services with usual medical care. Pharmacotherapy. 2010; 30(4):330-8. DOI: 10.1592/phco.30.4.330. View

13.

Tarus N, Pau A, Sereti I, Kirui F, Sawe F, Agan B . CHALLENGES IN MANAGEMENT OF WARFARIN ANTI-COAGULATION IN ADVANCED HIV/AIDS PATIENTS WITH VENOUS THROMBOTIC EVENTS--A CASE SERIES FROM A RESEARCH CLINIC IN RURAL KERICHO, KENYA. East Afr Med J. 2016; 90(7):207-13. View

14.

Sekaggya C, Nalwanga D, von Braun A, Nakijoba R, Kambugu A, Fehr J . Challenges in achieving a target international normalized ratio for deep vein thrombosis among HIV-infected patients with tuberculosis: a case series. BMC Hematol. 2016; 16:16. PMC: 4893228. DOI: 10.1186/s12878-016-0056-6. View

15.

Olsson S, Pal S, Dodoo A . Pharmacovigilance in resource-limited countries. Expert Rev Clin Pharmacol. 2015; 8(4):449-60. DOI: 10.1586/17512433.2015.1053391. View

16.

Moore T, Cohen M, Mattison D . Dabigatran, bleeding, and the regulators. BMJ. 2014; 349:g4517. DOI: 10.1136/bmj.g4517. View

17.

Chang A, Nabbaale J, Okello E, Ssinabulya I, Barry M, Beaton A . Outcomes and Care Quality Metrics for Women of Reproductive Age Living With Rheumatic Heart Disease in Uganda. J Am Heart Assoc. 2020; 9(8):e015562. PMC: 7428530. DOI: 10.1161/JAHA.119.015562. View

18.

Zeolla M, Brodeur M, Dominelli A, Haines S, Allie N . Development and validation of an instrument to determine patient knowledge: the oral anticoagulation knowledge test. Ann Pharmacother. 2006; 40(4):633-8. DOI: 10.1345/aph.1G562. View

19.

Nkoke C, Teuwafeu D, Mapina A, Nkouonlack C . A case series of venous thromboembolic disease in a semi-urban setting in Cameroon. BMC Res Notes. 2019; 12(1):40. PMC: 6339378. DOI: 10.1186/s13104-019-4092-8. View

20.

Matchar D . Do anticoagulation management services improve care? Implications of the Managing Anticoagulation Services Trial. Card Electrophysiol Rev. 2004; 7(4):379-81. DOI: 10.1023/B:CEPR.0000023144.60821.d1. View