CONCLUSION
There is significant room for improvement of anticoagulation control in
countries across SSA. Increasing numbers of patients will need
anticoagulation in the future because of the epidemiological transition
in the region. Despite the many challenges faced by patients, health
care providers, and health systems in these resource-limited settings,
several opportunities for improvement exist. Decentralisation of
anticoagulation care, together with expanded access to medicines and
monitoring, and enhanced support to practitioners and patients, are
pivotal in achieving better control. Dose initiation and dose adjustment
protocols that have been developed taking locally relevant factors into
account can also contribute to better anticoagulation control. With the
cost of DOACs still prohibitive, locally-developed “warfarin care
bundles” which address multiple anticoagulation challenges in
combination, particularly when they leverage off systems that are
already functional in SSA, currently appear to be the most appropriate
strategy to improve anticoagulation control in this setting.