Factors determining the use of NOACs vs. Warfarin in a Kenyan cohort of patients requiring anticoagulation

Abstract

Abstract Background Non-Vitamin K oral anticoagulants (NOACs) are widely used for stroke prevention in atrial fibrillation (AF) and prevention and treatment of venous thromboembolism (VTE). Apart from conditions in which warfarin is still the anticoagulant of choice, other factors may influence the choice between NOACs and warfarin. Purpose This study aims to determine factors associated with the use of NOACs as compared to warfarin in Kenya. Methods The Heart Registry Kenya is a prospective record of patients from two public hospitals and one private hospital in Kenya, with acute coronary syndrome, heart failure, AF, and VTE from 2020 to date. Data of patients with AF and VTE was analyzed to determine if demographic, clinical, or other non-clinical factors influence the choice of anticoagulants. The Chi-Square test was used to identify statistically significant associations between independent variables and dependent variables (NOACs or warfarin), with a 95% confidence interval. Results Data was collected on 452 patients (165 with AF and 288 with VTE) from 3 centers; the mean age was 51 years, and 61.7% were female. The proportions of patients on NOACs among AF and VTE patients were 60.5% and 57.5%, respectively (χ2: 0.122, p: 0.727). Proportions of patients on NOACs at public hospital number 1, public hospital number 2, and private hospital, were 37%, 50%, and 87.7%, respectively (χ2: 45.2, p: <0.001). The use of NOACs in low, mid-low, mid-high, and high income groups was 50.4%, 31.3%, 75%, and 88.2%, respectively (χ2: 23.4, p: <0.0001). There was no statistically significant association between the choice of anticoagulant and age, gender, race, renal function, indication for anticoagulation, use of antiplatelets, or extended anticoagulation therapy. Conclusion Patients with high socioeconomic status, as determined by monthly income and treatment facility, were more likely to be discharged on NOACs than warfarin. This may signal socioeconomic disparities affecting the treatment of AF and VTE in Kenya. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Fund - The Government of Kenya