Patient Associated Factors that Affect Adherence to Warfarin Therapy in a Tertiary Referral Hospital in Kenya

Abstract

Warfarin is the most widely used oral anticoagulant but non-adherence to its therapy contributes significantly to sub-optimal anticoagulation control. A crosssectional study was carried out among 147 adult outpatients at Kenyatta National Hospital to determine the level of adherence and explore the associated factors. Adherence was associated with age, gender heart valve surgery, alcohol consumption, and cost of treatment. On multivariate analysis, the independent variables associated with adequate adherence were age (OR = 0.429, 95% CI = 0.228-0.808; p = 0.009), gender (OR = 0.299, 95% CI = 0.123-0.728; p = 0.008) and the type of thromboembolic disease (OR = 0.385, 95% CI = 0.214-0.690; p = 0.001). Adherence was better among females, older age groups and patients who had undergone heart valve surgery. Adherence was poorer among males, younger participants and patients with venous thromboembolism. We suggest that medication adherence counseling to warfarin therapy should be emphasized in poor-adherent patient populations.

Key words: Warfarin, adherence, patient factors, Kenya