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Improving anticoagulation in sub-Saharan Africa -- what are the challenges, and how can we overcome them?
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  • Johannes Mouton,
  • Marc Blockman,
  • Christine Sekaggya-Wiltshire,
  • Jerome Semakula,
  • Catriona Waitt,
  • Munir Pirmohamed,
  • Karen Cohen
Johannes Mouton
University of Cape Town
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Marc Blockman
University of Cape Town
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Christine Sekaggya-Wiltshire
Makerere University College of Health Sciences
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Jerome Semakula
Makerere University College of Health Sciences
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Catriona Waitt
University of Liverpool Institute of Translational Medicine
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Munir Pirmohamed
University of Liverpool Institute of Translational Medicine, University of Liverpool
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Karen Cohen
Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Patients in sub-Saharan Africa generally have poor anticoagulation control. We review the potential reasons for this poor control, as well as the potential solutions. Challenges include the affordability and centralisation of anticoagulation care, problems with access to medicines and INR monitoring, the lack of locally-validated standardized dosing protocols, and low levels of anticoagulation knowledge among health care workers and patients. Increasing numbers of patients will need anticoagulation in the future because of the epidemiological transition in the region. We propose that locally-developed “warfarin care bundles” which address multiple anticoagulation challenges in combination may be the most appropriate solution in this setting currently.

Peer review status:Published

28 Jul 2020Submitted to British Journal of Clinical Pharmacology
29 Jul 2020Submission Checks Completed
29 Jul 2020Assigned to Editor
19 Aug 2020Reviewer(s) Assigned
03 Dec 2020Review(s) Completed, Editorial Evaluation Pending
06 Dec 2020Editorial Decision: Revise Minor
04 Jan 20211st Revision Received
05 Jan 2021Submission Checks Completed
05 Jan 2021Assigned to Editor
05 Jan 2021Review(s) Completed, Editorial Evaluation Pending
05 Jan 2021Reviewer(s) Assigned
05 Feb 2021Editorial Decision: Accept
10 Mar 2021Published in British Journal of Clinical Pharmacology. 10.1111/bcp.14768