Performance outcomes of a pharmacist‐managed anticoagulation clinic in the rural, resource‐constrained setting of Eldoret, Kenya

Performance outcomes of a pharmacist‐managed anticoagulation clinic in the rural, resource‐constrained setting of Eldoret, Kenya

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 v...

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Bibliographic Details
Published in:Journal of thrombosis and haemostasis Vol. 9; no. 11; pp. 2215 - 2220
Main Authors: MANJI, I., PASTAKIA, S. D., DO, A. N., OUMA, M. N., SCHELLHASE, E., KARWA, R., MILLER, M. L., SAINA, C., AKWANALO, C.
Format: Journal Article
Language:English
Published: Oxford, UK Blackwell Publishing Ltd 01-11-2011
Subjects:
Anticoagulants - therapeutic use
anticoagulation
Drug Monitoring
Health Resources - economics
Health Resources - standards
Health Resources - statistics & numerical data
Humans
Kenya
Mycobacterium
pharmacist
Pharmacists - economics
Pharmacists - standards
resource‐constrained
Retrospective Studies
Rheumatic Heart Disease
Rural Population
thromboembolism
Venous Thromboembolism - drug therapy
Venous Thromboembolism - epidemiology
warfarin
Warfarin - therapeutic use
Kenya
Africa
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Summary: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.
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ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/j.1538-7836.2011.04503.x