BACKGROUND: It is recommended that warfarin therapy should be managed through an anticoagulation monitoring service to minimize the risk of bleeding and subsequent thromboembolic events. There are few studies in Sub-Saharan Africa that describe warfarin management in spite of the high incidence of venous thromboembolism (VTE) and rheumatic heart disease. OBJECTIVE: To examine the feasibility of the Moi Teaching and Referral Hospital anticoagulation monitoring service and compare its performance with clinics in resource-rich settings. METHODS: A retrospective chart review compared the percentage time in the therapeutic range (TTR) and rates of bleeding and thromboembolic events to published performance targets using the inference on proportions test. Wilcoxon's rank sum analyses were used to establish predictors of TTR. RESULTS: For the 178 patients enrolled, the mean TTR was 64.6% whereas the rates of major bleeds and thromboembolic events per year were 1.25% and 5%, respectively. In the primary analysis, no statistically significant differences were found between the results of TTR, major bleeds and thromboembolic events for the clinic and published performance rates. In the secondary analysis, having an artificial heart valve and a duration of follow-up of > 120 days were positively associated with a higher TTR (P < 0.05) whereas venous thromboembolism, history of tuberculosis, HIV and a duration of follow-up of < 120 days were associated with having a lower TTR (P < 0.05). CONCLUSIONS: The performance of the MTRH anticoagulation clinic is non-inferior to published metrics on the performance of clinics in resource-rich settings.
BACKGROUND: It is recommended that warfarin therapy should be managed through an anticoagulation monitoring service to minimize the risk of bleeding and subsequent thromboembolic events. There are few studies in Sub-Saharan Africa that describe warfarin management in spite of the high incidence of venous thromboembolism (VTE) and rheumatic heart disease. OBJECTIVE: To examine the feasibility of the Moi Teaching and Referral Hospital anticoagulation monitoring service and compare its performance with clinics in resource-rich settings. METHODS: A retrospective chart review compared the percentage time in the therapeutic range (TTR) and rates of bleeding and thromboembolic events to published performance targets using the inference on proportions test. Wilcoxon's rank sum analyses were used to establish predictors of TTR. RESULTS: For the 178 patients enrolled, the mean TTR was 64.6% whereas the rates of major bleeds and thromboembolic events per year were 1.25% and 5%, respectively. In the primary analysis, no statistically significant differences were found between the results of TTR, major bleeds and thromboembolic events for the clinic and published performance rates. In the secondary analysis, having an artificial heart valve and a duration of follow-up of > 120 days were positively associated with a higher TTR (P < 0.05) whereas venous thromboembolism, history of tuberculosis, HIV and a duration of follow-up of < 120 days were associated with having a lower TTR (P < 0.05). CONCLUSIONS: The performance of the MTRH anticoagulation clinic is non-inferior to published metrics on the performance of clinics in resource-rich settings.
Authors: Caitlin Bernard; Chelsea Pekny; Christabell O Omukagah; Christian O Bernard; Imran Manji; Sonak D Pastakia; Astrid Christoffersen-Deb Journal: Contraception Date: 2018-08-01 Impact factor: 3.375
Authors: Cynthia A Binanay; Constantine O Akwanalo; Wilson Aruasa; Felix A Barasa; G Ralph Corey; Susie Crowe; Fabian Esamai; Robert Einterz; Michael C Foster; Adrian Gardner; John Kibosia; Sylvester Kimaiyo; Myra Koech; Belinda Korir; John E Lawrence; Stephanie Lukas; Imran Manji; Peris Maritim; Francis Ogaro; Peter Park; Sonak D Pastakia; Wilson Sugut; Rajesh Vedanthan; Reuben Yanoh; Eric J Velazquez; Gerald S Bloomfield Journal: J Am Coll Cardiol Date: 2015-12-08 Impact factor: 24.094
Authors: Charles Mve Mvondo; Marta Pugliese; Alessandro Giamberti; David Chelo; Liliane Mfeukeu Kuate; Jerome Boombhi; Ellen Marie Dailor Journal: Pan Afr Med J Date: 2016-08-11
Authors: Tim Mercer; Adrian Gardner; Benjamin Andama; Cleophas Chesoli; Astrid Christoffersen-Deb; Jonathan Dick; Robert Einterz; Nick Gray; Sylvester Kimaiyo; Jemima Kamano; Beryl Maritim; Kirk Morehead; Sonak Pastakia; Laura Ruhl; Julia Songok; Jeremiah Laktabai Journal: Global Health Date: 2018-05-08 Impact factor: 4.185