{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T03:52:05Z","timestamp":1781495525429,"version":"3.54.1"},"reference-count":46,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Warfarin use in Sub\u2010Saharan Africa is associated with elevated risks of thromboembolic events and bleeding, but precise prevalence estimates are lacking. This systematic review and meta\u2010analysis aimed to quantify the prevalence of bleeding and thromboembolic events among patients on warfarin in Sub\u2010Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Comprehensive searches were conducted in MEDLINE via Ovid, PubMed, Embase via Ovid, Scopus, and Google Scholar to identify relevant studies. Primary outcomes included major and minor bleeding events, while thromboembolic events were secondary outcomes. Meta\u2010analysis was conducted using RStudio version 4.3.3 with the meta and\n                      <jats:italic>\n                        <jats:styled-content>metaprop<\/jats:styled-content>\n                      <\/jats:italic>\n                      packages. Proportions were transformed using the Freeman\u2013Tukey double arcsine method, and meta\u2010regression was performed with the\n                      <jats:italic>\n                        <jats:styled-content>metafor<\/jats:styled-content>\n                      <\/jats:italic>\n                      package's\n                      <jats:italic>\n                        <jats:styled-content>escal<\/jats:styled-content>\n                      <\/jats:italic>\n                      ,\n                      <jats:italic>\n                        <jats:styled-content>rma<\/jats:styled-content>\n                      <\/jats:italic>\n                      , and\n                      <jats:italic>\n                        <jats:styled-content>res<\/jats:styled-content>\n                      <\/jats:italic>\n                      functions. Publication bias was assessed via funnel plots and Egger's test, with a\n                      <jats:italic>p<\/jats:italic>\n                      value &lt;\u20090.05 indicating potential bias. Sensitivity analysis was conducted through leave\u2010one\u2010out analysis. The review was performed in adherence to PRISMA guidelines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 10 observational studies for inclusion in this systematic review and meta\u2010analysis. Egger's test indicated no publication bias. Meta\u2010regression analysis showed that moderators (publication year, sample size, setting, and follow\u2010up duration) did not significantly impact bleeding risk. The pooled prevalence of major and minor bleeding was 18% (95% CI: 0.10\u20130.27;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      : 96%, prediction interval: 0.00\u20130.53), with rates ranging from 4% to 46%. Thromboembolic events occurred in 7% of warfarin users (95% CI: 0.01\u20130.07).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Warfarin therapy in Sub\u2010Saharan Africa is associated with considerable bleeding and thromboembolic risks. The robustness of these findings was confirmed through meta\u2010regression and sensitivity analyses, underscoring the need for improved therapeutic monitoring and safety strategies in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pds.70225","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T06:11:51Z","timestamp":1758867111000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Warfarin\u2010Associated Bleeding and Thromboembolic Events in Sub\u2010Saharan Africa: A Systematic Review and\u00a0Meta\u2010Analysis"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9384-7398","authenticated-orcid":false,"given":"Desalegn Getnet","family":"Demsie","sequence":"first","affiliation":[{"name":"Department of Pharmacy, College of Health Sciences Bahir Dar University  Bahir Dar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenaw Debasu","family":"Addisu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, College of Health Sciences Bahir Dar University  Bahir Dar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chernet","family":"Tafere","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, College of Health Sciences Bahir Dar University  Bahir Dar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bereket","family":"Bahiru","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, College of Health Sciences Bahir Dar University  Bahir Dar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malede Berihun","family":"Yismaw","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, College of Health Sciences Bahir Dar University  Bahir Dar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getahun","family":"Mihret","sequence":"additional","affiliation":[{"name":"St. Peter Hospital  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derbew Fikadu","family":"Berhe","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Biomedical Division, and Center for Equity in Global Surgery University of Global Health Equity  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2022.05.003"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA\u20102017\u2010029"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-314898"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569\u2010022\u201000787\u20106"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/JBM.S282948"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2020001830"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.4103\/2141\u20109248.141973"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA\u20102020\u2010006"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/08971900221116809"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.14097"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.23558"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.039579"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1740254"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.12926"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2021.06.021"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt\u20102019\u2010001232"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096\u2010017\u20100475\u2010x"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010017\u20102330\u20100"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40267-019-00630-y"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.4102\/phcfm.v8i1.1032"},{"key":"e_1_2_11_23_1","unstructured":"G. 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