Profiles of patients on warfarin anticoagulation therapy in a leading tertiary referral hospital in Kenya; findings and implications for Kenya

ABSTRACT

Background: Patients’ profiles affect the outcome with warfarin; however, this data, and its implications, is scarce in resource-poor countries without access to pharmacogenetics or regular INR testing.

Objectives: To characterize the profiles of patients on long-term warfarin therapy and subsequently use these to guide future anticoagulation management.

Methods: Cross-sectional study among 180 adult patients receiving warfarin therapy in at a leading referral hospital in Kenya. Sociodemographic characteristics were obtained through face-to-face interviews. Details of warfarin therapy, concomitant medication and comorbidities were retrieved from medical records. Associations between patients’ profiles and the clinical indications of anticoagulation were computed at p ≤ 0.05.

Results: Warfarin maintenance dose was 6.17 (±2.75) mg per day. Venous thromboembolism (56.6%) amongst obese patients (p = 0.0019) and cardioembolic events (48.3%) among males (p = 0.0316) aged ≤50 years (p = 0.0436) whose body mass indices were ≤ 25 (p < 0.0001) were the most common indications. Two-fifths and 45.0% of the patients had at least one other disease and concomitant medications.

Conclusions: Long term warfarin therapy among Kenyans is mainly for overweight or lean middle-aged individuals suffering from venous or cardioembolic diseases. Studies should correlate patients’ profiles with warfarin response to guide future management.

KEYWORDS:

• Warfarin Anticoagulation Therapy
• Warfarin
• patient Profiles
• Kenya

Article highlights

• The majority of Kenyans receiving long-term warfarin therapy are in their middle-ages, which are the highly economically productive years of the population. Early prevention and optimal management of the coagulation disorders may subsequently increase productivity among the affected population.

• Anticoagulation management among patients in Kenya is essentially for venous or cardiac related thromboembolic disorders.

• Cardioembolic disorders are significantly more common in lean males aged ≤50 years whilst venous thromboembolic disorders are principally seen in females and obese individuals. Clinicians should be aware that obesity may aggravate the management of venous thromboembolic events.

• Kenyan patients, especially those with venous thromboembolic events, require high daily maintenance doses of warfarin.

• The significant association of the marital status and the development of VTEs or cardioembolic events require further research.

Acknowledgments

The authors acknowledge all staff at anticoagulation clinics of KNH for the immeasurable support during the study. The authors also acknowledge all patients who willingly participated in the study.

Authors’ contributions

DN conceptualized the idea, wrote the concept, collected and analyzed the data and drafted the manuscript. AG assisted with proposal development, data analysis and interpretation as well as writing the manuscript. GO and EA reviewed the proposal, data analysis and revised the manuscript, with BBG helping with the data analysis and the manuscript review.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Authors declare no conflict of interest.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data Availability

Datasets used are available on request (Email: [email protected])

Additional information

Funding

This work was entirely self-funded by the corresponding author.