Evaluation of Anticoagulation Management Practices in Patients with Atrial Fibrillation at the National Orthopaedic Hospital, Enugu, South East Nigeria

This study evaluates anticoagulation management practices in patients with atrial fibrillation (AF) undergoing care at the National Orthopaedic Hospital, Enugu, South East Nigeria. Atrial fibrillation represents a significant thromboembolic risk, and appropriate anticoagulation management is critical, particularly in patients undergoing orthopaedic procedures where both thrombotic and bleeding risks are heightened. A retrospective cross-sectional audit reviewed the records of 120 AF patients managed at the cardiology liaison service of the hospital over two years. Data extracted included anticoagulant type prescribed, INR monitoring frequency, time in therapeutic range (TTR), peri-operative anticoagulation bridging strategies, and documented thromboembolic and bleeding events. Warfarin was the anticoagulant used in 87 percent of patients. Mean TTR was 48 percent, well below the minimum recommended 65 percent threshold. INR monitoring intervals exceeded recommended frequencies in 54 percent of patients. Direct oral anticoagulants (DOACs) were used in 13 percent of patients, all without systematic monitoring. Bridging therapy was incorrectly applied in 38 percent of peri-operative cases, with potential over-anticoagulation in some and under-protection in others. The study recommends establishing a dedicated anticoagulation clinic with pharmacist-led monitoring, DOAC prescribing training for specialists, structured peri-operative bridging protocols, and patient education programmes at the National Orthopaedic Hospital Enugu. Keywords: anticoagulation management, atrial fibrillation, warfarin, time in therapeutic range, Enugu.