{"title":"Anticoagulation quality through time in therapeutic range in Sub-Saharan Africa: a systematic review and meta-analysis.","authors":"Desalegn Getnet Demsie, Zenaw Debasu Addisu, Chernet Tafere, Kebede Feyisa, Bereket Bahiru, Malede Berihun Yismaw, Getahun Mihret, Abere Tilahun, Desye Gebrie, Derbew Fikadu Berhe","doi":"10.3389/fmed.2025.1517162","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>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>I</i> <sup>2</sup> and prediction intervals (PI), and publication bias assessed through funnel plots and Egger's test, with <i>p</i> < 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.</p><p><strong>Results: </strong>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>I</i> <sup>2</sup> = 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>I</i> <sup>2</sup> = 86%; prediction interval: 0.16, 0.67).</p><p><strong>Conclusion: </strong>Warfarin therapy is associated with very low percentage of TTR suggests poor quality of anticoagulation management. Sensitivity analyses confirmed the robustness of these findings.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1517162"},"PeriodicalIF":3.1000,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949880/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fmed.2025.1517162","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
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 I2 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% (I2 = 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% (I2 = 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.
期刊介绍：
Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate
- the use of patient-reported outcomes under real world conditions
- the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines
- the scientific bases for guidelines and decisions from regulatory authorities
- access to medicinal products and medical devices worldwide
- addressing the grand health challenges around the world
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