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Patterns of Ambulatory Anticoagulation Practices in a County Hospital in Nairobi

Author: Nyamu G. D , Guantai A. N
Is Part Of: Pharmaceutical Journal of Kenya, Volume 23, No. 3 (2018)
Background: Anticoagulation services are substantially underutilized in Kenya, especially in the absence of local clinical guidelines, resulting in avoidable fatal and disabling complications such as bleeding and thromboembolic disorders.
Study Objectives: To describe the patterns of ambulatory anticoagulation services and determine factors impacting on its practice at Mbagathi District Hospital, Nairobi County.
Study design and Setting: Cross-sectional study at Mbagathi District Hospital, medical outpatient clinic.
Participants and Methods: Eighteen consenting prescribers to anticoagulants were interviewed using universal sampling. Information on their sociodemographics, prescribing habits of anticoagulants, utilization of anticoagulation guidelines in prescribing and factors impacting on the uptake of anticoagulation were assessed.
Data Analysis: Database was created into Microsoft Access version 2013 and exported to IBM Statistical Package for Social Sciences version 21.0 for analysis. Continuous variables were further analyzed using measures of central tendencies. Student-t-test and Pearson’s chi square were used to draw associations and inferences. Confidence interval was set at 95% with p-values ≤0.05 being statistically significant.
Results and Discussion: The prescribers were aged 30.1(±7.4), ranging 22-48 years. The male to female ratio was approximately 1:1. Two-thirds of the prescribers were registered clinical officers and almost three-quarters (72.2%) had practiced for less than four years. The principal prescribing for anticoagulant therapy was deep vein thrombosis (55.9%) and prevention of thrombosis after heart valve surgery (39.2%). Initial prescribed warfarin doses were inconsistent with guidelines (p=0.01). Prescribers were unaware of the availability of various strengths of warfarin tablets. Additionally, there were inconsistencies in the management of patients presenting with under or over anticoagulation. There was lack of multidisciplinary team approach in anticoagulation services as over 70% were either nurses, clinical officers or medical officers but few pharmacists. Uptake of anticoagulation services could be increased by participation of pharmacists as well as hospital management support in formulation of local guidelines and provision of equipment for testing the level of anticoagulation.
Conclusions and Recommendations: Ambulatory anticoagulation clinic services in the hospital are poor because there is underutilization of international guideline coupled with lack of local clinical guidelines and inadequate hospital support. In addition, multidisciplinary team approach is recommended for improvement of anticoagulation services.

Keywords: Anticoagulation, Anticoagulation prescribing practices, Warfarin, County Hospital
Publisher: The Pharmaceutical Society of Kenya
ISSN: 2411-6386