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April 13, 2026International Journal of General MedicineOpen Access

Determinants of Suboptimal INR Control in Eritrean Post–Cardiac Surgery Patients: Insights from a Low-Resource Setting

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Why the study?

What demographic, clinical, and treatment-related factors affect INR control in Eritrean adults on long-term warfarin following cardiac surgery?

Population

93 Eritrean adults on long-term warfarin following cardiac surgery, median age 45 years, 37.5% male.

Design

Cohort

Follow-up

median 60 days (IQR: 24–120 days)

Authors

SMSamuel MengistuDSDesawit SiyumHTHabtemichael M. Teklemariam

Discussion

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Overview

In a low-resource setting, post-cardiac surgery patients on warfarin had suboptimal INR control (median TTR 47.8%), with mechanical valves, higher therapeutic targets, and specific co-medications driving INR variability.

Key Points

  • This research aimed to identify factors related to poor anticoagulation control in Eritrean patients on warfarin post-cardiac surgery.
  • Conducted a retrospective observational cohort study
  • Included Eritrean adults who had cardiac surgery in Sudan and returned for follow-up
  • Data collected between February 2020 and July 2021
  • Assessed INR control using Time in Therapeutic Range (TTR) via the Rosendaal method
  • Used linear mixed-effects modeling to identify predictors of INR variability.
  • Median TTR was 47.8%, with only 25% achieving optimal control (TTR ≥ 60%)
  • Mechanical valve replacement and higher therapeutic targets were significant predictors of INR variability
  • Conditions like COPD/asthma were associated with poorer control
  • Co-medications like aspirin and digoxin influenced INR outcomes.

Structured PICO

What demographic, clinical, and treatment-related factors affect INR control in Eritrean adults on long-term warfarin following cardiac surgery?

P
Population
93 Eritrean adults (≥ 18 years) on long-term warfarin following cardiac surgery (62% valvular heart disease, 67% metallic valve replacement), median age 45 years, 37.5% male.
I
Intervention
Long-term warfarin therapy
O
Outcome
INR control assessed using Time in Therapeutic Range (TTR) via the Rosendaal methodsurrogate

In a low-resource setting, post-cardiac surgery patients on warfarin had suboptimal INR control (median TTR 47.8%), with mechanical valves, higher therapeutic targets, and specific co-medications driving INR variability.

Limitations

  • sample size
  • single-center design

Cite This Study

Mengistu et al. (2026) studied this question.

synapsesocial.com/papers/69dc887f3afacbeac03ea5c8https://doi.org/10.2147/ijgm.s568871
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Anticoagulation Control and Associated Factors in Patients with Atrial Fibrillation Receiving Warfarin at a Tertiary Care Hospital in Nepal2025
  2. 2Evaluation of Anticoagulation Quality Among Older Adults Receiving Warfarin: A Systematic Review2026
  3. 3Challenges with international normalised ratio control in paediatric patients with rheumatic heart valve replacement surgery in the Eastern Cape Province, South Africa2025
  4. 4Evaluation and Optimization of INR Goals in Patients With Mechanical Aortic Valves in a Pharmacist-Run Clinic: An Anticoagulation Stewardship Initiative2025
  5. 5Establishing Warfarin Clinics for improved Anticoagulation Management in Ethiopia2025