Attainment of Target in Therapeutic Range of International Normalized Ratio and Correlates Among Patients on Warfarin Therapy at Jimma Medical Center, Jimma, Ethiopia

• Published in: Clinical therapeutics 2024-04, Vol.46 (4), p.354-359
• Main Authors: Jada, Abdulkadir Urgessa, Disassa, Gashahun Mekonnen, Melesse, Belete Habte, Abafogi, Mohammed Mecha, Abera, Eyob Girma, Jibicho, Kelil Hussein, Tukeni, Kedir Negesso
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcohol; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; anticoagulation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Cardiac arrhythmia; Cardiovascular diseases; Comorbidity; Cross-Sectional Studies; Data collection; Drug dosages; Ethiopia; Female; Fibrillation; Health care facilities; Heart diseases; Hospitals; Humans; International Normalized Ratio; Jimma Medical Center; Male; Middle Aged; Morbidity; Patient compliance; Patients; Population; Prostheses; Prosthetics; Quality of life; Regression analysis; Rural areas; Sociodemographics; Software; target therapeutic range; Therapy; Thromboembolism; Thrombosis; Warfarin; Warfarin - administration & dosage; Warfarin - adverse effects; Warfarin - therapeutic use; Young Adult
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2024.01.010

Warfarin is effective therapy to prevent thromboembolic complications of venous thromboembolism, atrial fibrillation, and cardiac thrombus, among valvular heart diseases, including in patients treated with prostheses and/or repair. Its optimum effect is achieved when the international normalized ratio (INR) is in the target therapeutic range, but a subtherapeutic level increases risk of thromboembolism and complications. This study aimed to assess the attainment of target therapeutic range, proportion, and factors associated with subtherapeutic level of warfarin. A hospital-based cross-sectional study was conducted at Jimma Medical Center in Jimma, Ethiopia, from October 1, 2020 through December 30, 2021. All patients on warfarin and attending Medical Follow-Up Clinics of Jimma Medical Center during the study period were included. Data were collected using structured questionnaires and then analyzed using EpiData Manager software, version 3.1 (EpiData Association). χ2 Tests and logistic regression models were used to assess relationships among variables. Of 196 patients on warfarin, ∼60% were taking it for atrial fibrillation, followed by deep venous thrombosis, women accounted for 61.7% of patients, and mean (SD) age was 43 (7) years. Most patients (61.7%) lived in rural areas and 44.9% farmed to earn a living. Most of the study participants (51.5%) had a very low monthly income of less than USD50. Most of the patients (n = 107 [54.6%]) were advised on dietary selections while on warfarin and approximately two-thirds (n = 70 [65.4%]) were adherent to the advice. Most participants (n = 118 [60.2%]) were poorly adherent to warfarin therapy and more than two-thirds of them discontinued warfarin for financial reasons. Mean (SD) duration of warfarin therapy was 15.53 (18.92) months (range 1–90 months). Most of the respondents (n = 109 [55.6%]) had subtherapeutic INR and 21 (10.7%) were in the supratherapeutic range. Although the mean (SD) time in therapeutic range was 25.03% (24.17% [range 0–80%]), in most patients (n = 166 [84.7%]), it was