Because of the higher prevalence of TB and emerging availability of anticoagulation services in this setting, there exists a growing population of patients who are facing this drug interaction [18, 19]. Even though anticoagulation clinics have been shown to improve patient outcomes when compared to individual physician care, the limited data concerning this drug–drug interaction in this population presents an enormous challenge to clinicians providing care to patients on concomitant rifampicin

and warfarin therapy [2]. Without https://www.selleckchem.com/products/chir-99021-ct99021-hcl.html data from patients receiving care in developing countries, clinicians have to rely primarily on the previously published case reports conducted only in developed countries, some of which suggest the need to increase warfarin doses by greater than 100–200 % [5, 9, 10]. The objective of this case series is to provide insight to practicing clinicians on the unique dynamics of the drug interaction between rifampicin and warfarin therapy in a resource-constrained setting in western Kenya. The case series will provide details on commonly encountered scenarios in these settings and the adjustments made to maintain a therapeutic INR. With the high numbers of TB infected patients within this setting, this represents one of the largest case series on this often encountered drug interaction and the first which considers the unique characteristics

of patients within a rural resource-constrained setting. 2 Methods The study is a retrospective chart review of patients receiving concurrent anti-TB medications containing rifampicin and oral anticoagulation therapy with warfarin. This study Fulvestrant was conducted in a pharmacist-managed anticoagulation clinic

within the Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. The anticoagulation clinic was established through a partnership formed by the Purdue University College of Pharmacy, the Academic Model Providing Access to Healthcare (AMPATH), MTRH and Moi University School of Medicine [20]. The clinic was developed as AMPATH expanded its Aprepitant scope of practice from the human immunodeficiency virus (HIV) pandemic to chronic disease management and primary health care. Since the clinic’s inception in December 2008, it has served over 700 patients and currently has more than 350 active patients. The majority of patients are enrolled into the anticoagulation clinic through referrals from MTRH clinicians providing health services in the public inpatient and outpatient clinics. Most patients are referred from the cardiology, obstetrics/gynecology, internal medicine and hematology/oncology departments. The most common indications for anticoagulation in the clinic include VTE, valvular damage secondary to rheumatic heart disease (RHD) and atrial fibrillation. Patients with mechanical heart valves and other cardiomyopathies also receive anticoagulation therapy within the clinic [18].