| Title: |
Anticoagulation quality through time in therapeutic range in Sub-Saharan Africa: a systematic review and meta-analysis |
| Authors: |
Demsie DG; Addisu ZD; Tafere C; Feyisa K; Bahiru B; Yismaw MB; Mihret G; Tilahun A; Gebrie D; Berhe DF. |
| Publication Year: |
2025 |
| Collection: |
National Academic Digital Repository of Ethiopia |
| Description: |
Background: The quality of anticoagulation with warfarin is often assessed through the time in therapeutic range (TTR). However, achieving optimal TTR and maintaining therapeutic INR levels presents significant challenges in Sub-Saharan Africa. This review aims to summarize the existing evidence on the quality of warfarin anticoagulation among patients in Sub-Saharan Africa. Method: We searched MEDLINE via Ovid, PubMed, Embase via Ovid, and Scopus, and citation analysis from Google Scholar. The review's primary focus was therapeutic INR and TTR ≥ 65. Meta-analysis was conducted using R version 4.3.3. A mixed-effects meta-regression model was used to examine the influence of moderators, with heterogeneity estimated using I 2 and prediction intervals (PI), and publication bias assessed through funnel plots and Egger's test, with p < 0.05 indicating potential bias. The robustness of pooled proportions was tested using a leave-one-out sensitivity analysis. The preparation of this review adhered to the guidelines outlined in the PRISMA. Results: We identified 15 observational studies for inclusion in this systematic review and meta-analysis. Egger's test confirmed an absence of publication bias across these studies. Sensitivity analyses showed consistency in individual therapeutic INR (pooled estimate: 0.37; range: 0.37-0.40) and TTR (pooled estimate: 0.16; range: 0.15-0.17), closely aligning with pooled proportions. Meta-analysis of high-quality TTR measurements yielded a pooled prevalence of 17% (I 2 = 89%), with study-specific values ranging from 10 to 29% and predicted effect sizes between 0.05 and 0.34. The therapeutic INR was observed at a pooled prevalence of 40% (I 2 = 86%; prediction interval: 0.16, 0.67). Conclusion: Warfarin therapy is associated with very low percentage of TTR suggests poor quality of anticoagulation management. Sensitivity analyses confirmed the robustness of these findings. |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
pmid:40160323; https://zenodo.org/record/10269; oai:zenodo.org:10269 |
| DOI: |
10.3389/fmed.2025.1517162 |
| Availability: |
https://zenodo.org/record/10269; https://doi.org/10.3389/fmed.2025.1517162 |
| Rights: |
info:eu-repo/semantics/openAccess ; https://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.53E3B158 |
| Database: |
BASE |