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Anticoagulation in sub-Saharan Africa: Are Direct Oral Anticoagulants the answer? A review of lessons learnt from warfarin
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  • Jerome Semakula,
  • Geraldine Kisa,
  • Johannes Mouton,
  • Karen Cohen,
  • Marc Blockman,
  • Munir Pirmohamed,
  • Christine Sekaggya-Wiltshire,
  • Catriona Waitt
Jerome Semakula
Makerere University College of Health Sciences
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Geraldine Kisa
Makerere University College of Health Sciences
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Johannes Mouton
University of Cape Town
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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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Marc Blockman
University of Cape Town
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Munir Pirmohamed
University of Liverpool Institute of Translational Medicine
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Christine Sekaggya-Wiltshire
Makerere University College of Health Sciences
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Catriona Waitt
University of Liverpool Institute of Translational Medicine
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Abstract

Warfarin has existed for more than seven decades and has been the anticoagulant of choice for many thromboembolic disorders. The recent introduction of direct acting oral anticoagulants (DOACs) has however caused a shift in preference by healthcare professionals all over the world. DOACs have been found to be at least as effective as warfarin in prevention of stroke in patients with atrial fibrillation and in treatment of venous thromboembolism. In sub-Saharan Africa, however, the widespread use of DOACs has been hampered mainly by their higher acquisition costs. As the drugs come off patent, their use in sub-Saharan Africa is likely to increase. However, very few trials have been conducted in African settings, and safety concerns will need to be addressed with further study before widespread adoption into clinical practice.

Peer review status:Published

06 Nov 2020Submitted to British Journal of Clinical Pharmacology
09 Nov 2020Submission Checks Completed
09 Nov 2020Assigned to Editor
13 Nov 2020Reviewer(s) Assigned
06 Dec 2020Review(s) Completed, Editorial Evaluation Pending
06 Dec 2020Editorial Decision: Revise Major
13 Jan 20211st Revision Received
20 Jan 2021Submission Checks Completed
20 Jan 2021Assigned to Editor
20 Jan 2021Review(s) Completed, Editorial Evaluation Pending
25 Jan 2021Reviewer(s) Assigned
18 Feb 2021Editorial Decision: Accept
23 Feb 2021Published in British Journal of Clinical Pharmacology. 10.1111/bcp.14796