Evaluation of Warfarin Anticoagulation at University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia

Abstract

Purpose

To assess the quality of warfarin anticoagulation and its clinical outcomes on patients treated with warfarin at the University of Gondar comprehensive specialized hospital, North-west Ethiopia.

Methods

We reviewed medical records of patients treated with warfarin between June 1, 2016, and May 30, 2018, at the University of Gondar comprehensive specialized hospital. The quality of anticoagulation was evaluated using the percentage of time spent in the therapeutic range. Data were entered into Statistical Product and Service Solutions (SPSS), version 20. Descriptive statistics were used to describe the socio-demographic and clinical characteristics of study participants. Multivariable logistic regression analysis was performed to identify independent predictors of quality of anticoagulation. Statistical significance was declared when the p-value was less than 0.05 at 95% confidence interval (CI).

Results

From a total of 202 patients’ charts reviewed, women accounted for 134 (67.3%). The mean participants’ age was 44.33 years (±17.05years SD). The median time spent in the therapeutic range was 37.91 with an IQR of (0.00–65.86). More than two-third (143, (70.8%)) of participants had poor anticoagulation quality (time spent in the therapeutic range is less than 65%). Twenty-seven patients (13.4%) experienced adverse medication events of bleeding and thromboembolic events. Logistic regression analysis showed that potential medication interaction [p= 0.003 95% CI Adjusted odds ratio (AOR): 0.32 (0.152–0.689)] and presence of co-morbidity [p= 0.037 95% CI AOR: 0.70 (1.046–4.105)] were significantly associated with quality of anticoagulation.

Conclusion

The quality of warfarin anticoagulation at the University of Gondar comprehensive specialized hospital was poor. A strong effort is needed to improve the quality of anticoagulation. Patients who had other co-morbidity conditions and potentially interacting medication need special attention.

Keywords:

• warfarin
• anticoagulation
• University of Gondar
• TTR
• Ethiopia

Abbreviations

AOR, Adjusted Odds Ratio; CVD, Cardio Vascular Disease; DVT, Deep Venous Thrombosis; INR, International Normalization Ratio; ISI, International Sensitivity Index; MI, Myocardial Infarction; OR, Odds Ratio; PE, Pulmonary Embolism; SD, Standard Deviation; TTR, Time in Therapeutic Range; VKA, Vitamin K Antagonist; VTE, Venous Thrombo Embolism; UoGCSH, University of Gondar comprehensive Specialized Hospital.

Data Sharing Statement

The datasets during and/or analyzed during the current study are available from the author on reasonable request.

Acknowledgments

We would like to thank the University of Gondar for funding this research project. We are also very grateful to the nursing staffs of the chronic outpatient department of UoGCSH for their cooperation in the data collection process.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was done with the financial support of the University of Gondar.