Pooled estimate of anticoagulation control with warfarin therapy among adult patients in Ethiopia: a systematic review and meta-analysis

Warfarin is widely used to prevent thromboembolic events; however, achieving optimal anticoagulation control remains challenging. In Africa, Time in Therapeutic Range (TTR) is generally low, and no nationally representative pooled estimate exists for Ethiopia. To estimate adequate anticoagulation control (TTR ≥ 65%) among adult patients receiving warfarin therapy in Ethiopia. A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD420251271413). Databases including PubMed/MEDLINE, Scopus, Embase, Web of Science, African Journals Online, and Google Scholar were searched from inception to December 10, 2025. Observational studies conducted in Ethiopia among adult warfarin users reporting TTR were included, while studies lacking relevant outcomes or involving non-adult populations were excluded. Study quality was assessed using the Joanna Briggs Institute tool. A random-effects model was applied to estimate pooled anticoagulation control, and heterogeneity was evaluated using the I² statistic. Six studies comprising a total of 2,022 participants were included in this systematic review and meta-analysis. All studies were retrospective cross-sectional and conducted among adult patients receiving warfarin therapy in hospital settings across Ethiopia. The pooled estimate of adequate anticoagulation control (TTR ≥ 65%) was 34.30% (95% CI: 28.16–40.44), with substantial heterogeneity (I² = 79.09%). The mean TTR ranged from 29% to 47.24% across the included studies. Subgroup analysis showed relatively higher anticoagulation control in Addis Ababa (39.29%) compared to other regions (Amhara and Oromia) (22.19%). Anticoagulation control among Ethiopian patients on warfarin is suboptimal. Strengthening anticoagulation management services and establishing dedicated clinics are recommended.