Trends of Optimal Anti-Coagulation For Patients with Atrial fibrillation at Tikur Anbesa Specialized Hospital, Cardiology Unit
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Date
2025-04-15
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Addis Ababa University
Abstract
Background:Atrial fibrillation (AF) is a major risk factor for stroke, and proper anticoagulation management is one of the main pillars of treatment of atrial fibrillation to prevent cardioembolic complications.However, data on anticoagulation practices and quality are limited in Ethiopia. Identifying gaps in anticoagulation management is critical for improving patient outcomes and reducing stroke-related morbidity in low-resource settings.
Objective: to determine the status of anticoagulation therapy in high risk atrial fibrillation patients and identify predictors of suboptimal anticoagulation in high-risk AF patients who had follow up at TikurAnbessa specialized hospital (TASH), Ethiopia.
Methods: A retrospective cohort study was conducted at TASH from March to September 2024. Data were extracted from electronic and paper records, including demographics, commodities, anticoagulant type, and INR values. For those taking warfarin, anti-coagulation quality was assessed using Time in Therapeutic Range (TTR) with a target TTR of ≥65%. Data analysis was performed using SPSS version. Multivariable logistic regression was applied to identify predictors of suboptimal anticoagulation, with statistical significance set.
Results: A total of 173 adults with high risk AF (mean age 64.7 ± 13.2 years; 64.7% female) were included. Of these, 90.2% were anticoagulated, while 9.8% were untreated despite being at high stroke risk. Among the 108 warfarin users, 76.9% had suboptimal International Normalized Ratio (INR) control (TTR ≤65%). Direct oral anticoagulants (DOACs) were prescribed to 30.7% (48/156) of anticoagulated patients, with 20.8% (10/48) exhibiting suboptimal anticoagulation. Overall, 59.6% (93/156) of anticoagulated patients had suboptimal anticoagulation. Logistic regression identified increasing age (AOR = 1.05, 95% CI: 1.02–1.09, p = 0.001) and community-based health insurance (CBHI) enrollment (AOR = 2.24, 95% CI: 1.08–4.67, p = 0.03) as significant predictors of suboptimal anticoagulation. Conclusion: Suboptimal anticoagulation remains a significant challenge in Ethiopia, driven by factors such as age and CBHI. Addressing these issues through expanded insurance coverage, point-of-care INR testing, and targeted provider education is essential to improving outcomes for AFpatients.
Keywords: AF, anticoagulation, warfarin, DOACs, Ethiopia, low-resource settings.
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AF anticoagulation warfarin DOACs Ethiopia low-resource settings.