ArticleInternational journal of general medicine2026
Determinants of Suboptimal INR Control in Eritrean Post-Cardiac Surgery Patients: Insights from a Low-Resource Setting.
Article in International journal of general medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Warfarin remains the mainstay of long-term anticoagulation in low-resource settings; however, maintaining optimal international normalized ratio (INR) control is challenging, particularly in countries with limited follow-up services. In Eritrea, patients requiring lifelong anticoagulation often undergo cardiac surgery abroad yet face barriers to consistent INR monitoring upon return. Objective: To identify demographic, clinical, and treatment-related factors associated with poor anticoagulation control among Eritrean patients on long-term warfarin following cardiac surgery. Methods: We conducted a retrospective observational cohort study of Eritrean adults (≥18 years) who underwent cardiac surgery at the Salam Centre for Cardiac Surgery in Sudan and returned to Eritrea for follow-up. Data were collected from patients followed between February 2020 and July 2021 (median follow-up: 60 days, IQR: 24-120 days). INR control was assessed using Time in Therapeutic Range (TTR) via the Rosendaal method. Linear mixed-effects modeling identified predictors of INR variability. Results: Ninety-three patients (37.5% male, median age 45 years) met inclusion criteria. Median TTR was 47.8% (IQR: 33.2-62.9%), with only 25% achieving optimal control (TTR ≥60%). Valvular heart disease was the leading indication (62%), with 67% having metallic valve replacement. Mixed-effects modeling identified mechanical valve replacement (exp(β)=1.26, 95% CI: 1.17-1.37), higher therapeutic target (exp(β)=1.21), COPD/asthma (exp(β)=0.71), and specific co-medications (aspirin, digoxin, enalapril) as significant determinants of INR variability. Conclusion: In this cohort, anticoagulation control was suboptimal for the majority. Mechanical valve replacement, therapeutic targets, and specific co-medications were significant determinants of INR variability. These findings, while limited by sample size and single-center design, suggest that targeted medication review and individualized therapeutic targets may improve anticoagulation outcomes in similar low-resource settings.
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