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Needs assessment analysis for vitamin K antagonist anticoagulation in the resource-constrained setting of Eldoret, Kenya.

OBJECTIVES
To assess the frequency of indications for vitamin K antagonist (VKA) therapy in the inpatient and outpatient setting in Eldoret, Kenya, and to describe the strategies used for managing these conditions.


METHODS
All inpatient admissions during a 1.5-month period were prospectively assessed for any indications for VKA therapy by clinical pharmacy staff. For the outpatient assessment, the files of all patients receiving care in the outpatient adult cardiology clinic within the previous 6 months were identified and evaluated for indications for VKA therapy. For patients identified with an indication for VKA therapy, additional information was collected, including the VKA indication, pharmacologic management, and any other risk-modifying conditions.


RESULTS
In the primary analysis, 20 of the 554 patients admitted to the public adult wards (3.61% [95% CI 2.14-5.08]) were candidates for VKA therapy. Of the 168 outpatient cardiology clinic charts reviewed, 72 patients (42.8% [37.96-47.76]) had indications for VKA therapy. In the secondary analysis, 70% of the inpatient population and 93% of the outpatient population received suboptimal VKA therapy. Of these patients in need of VKA therapy, 53.3% were on aspirin therapy only and 33.7% were not receiving any pharmacologic therapy.


CONCLUSION
As developing countries begin to address the growing burden of chronic diseases, a commensurate focus on providing infrastructure for comprehensive cardiovascular care, including an organized VKA monitoring service, needs to occur.