Profiles of patients on warfarin anticoagulation therapy in a leading tertiary referral hospital in Kenya; findings and implications for Kenya.

Abstract

Background: Patients' profiles affect the outcome with warfarin; however, this data, and its implications, is scarce in resource-poor countries such as Kenya without access to pharmacogenetics or regular INR testing.Objectives: To characterize the profiles of patients on long-term warfarin therapy and subsequently use the findings to guide future anticoagulation management.Methods: Cross-sectional study undertaken among 180 adult patients receiving warfarin therapy in anticoagulation clinics at a leading referral hospital in Kenya. Sociodemographic characteristics were obtained through face-to-face interviews. Details of warfarin therapy, concomitant medication and comorbidities were retrieved from medical records. Associations between patients' profiles and the clinical indications of anticoagulation were computed p≤0.05.Results: Warfarin maintenance dose was 6.17 (±2.75) mg per day. Over 70% of patients received warfarin maintenance doses of ≥6mg per day. Venous thromboembolism (56.6%) amongst obese patients (p=0.0019) and cardioembolic events (48.3%) among males (p=0.0316) aged ≤50 years (p=0.0436) whose body mass indices were ≤ 25 (p<0.0001) were the most common indications. Two-fifths and 45.0% of the patients had at least one other disease and concomitant medications.Conclusions: Long term warfarin therapy among Kenyans is mainly for overweight or lean middle-aged individuals suffering from venous or cardioembolic diseases and requires high daily doses. Studies should correlate patients' profiles with warfarin response to guide future management.