Establishing Warfarin Clinics for improved Anticoagulation Management in Ethiopia

Abstract

Warfarin is essential for preventing thromboembolic complications in patients with atrial fibrillation and prosthetic heart valves, who are at significant risk for stroke, systemic embolism, and valve thrombosis. Warfarin, while highly effective in reducing stroke risk by up to 64%, presents a narrow therapeutic window, making both under- and over-anticoagulation dangerous and sometimes fatal. Careful and regular monitoring of the INR is therefore essential, as patients without consistent follow-up are much more likely to experience adverse events, underscoring the rationale for dedicated Warfarin clinics.

Warfarin clinics were established for the first time in Addis Ababa, Awassa, Gondar, and Bahir Dar, supervised by the Cardiac Centre Ethiopia in collaboration with Aswan Heart Centre and Chain of Hope to improve anticoagulation management and decrease adverse events. 

Patients with AF or prosthetic valves were enrolled without exclusion criteria. Each visit includes INR testing using point-of-care devices, assessment and adjustment of Warfarin dosage, and provision of Warfarin. The clinics also monitor for complications by recording symptoms, recent hospitalizations, and adverse events. Compliance with warfarin protocol and treatment practices were monitored. Patient education improves clinical outcomes but also empowers patients to participate actively in their care, fostering better compliance and understanding of the therapy’s risks and benefits.

Regular follow-up, reinforces the importance of adherence and timely adjustments to therapy. The use of standardized forms and registries ensures comprehensive data collection and continuity of care. This structured, multidisciplinary approach not only reduces preventable complications but also provides a scalable model for anticoagulation management in resource-limited settings.