Bridging Geographic and Linguistic Gaps in Anticoagulation: A Pharmacist-Led Telemedicine Cohort Study of Warfarin Patients From Pakistan, Afghanistan, and Iran.

BACKGROUND: Warfarin therapy necessitates precise monitoring using the International Normalized Ratio (INR) owing to its narrow therapeutic index. Patients in remote regions of Pakistan, Afghanistan, and Iran face significant barriers to regular health care access, compounded by language barriers when health care is not provided in their native languages. The objectives of this study are to evaluate pharmacist-led telemedicine delivered in native languages on anticoagulation control, monitoring adherence, and clinical outcomes among warfarin-treated patients from remote, linguistically isolated regions of Pakistan, Afghanistan, and Iran. METHODS: In this retrospective cohort study, 200 adults on warfarin and registered at the National Institute of Cardiovascular Diseases (NICVD) anticoagulation clinic, who spoke Pashto or Persian/Dari and could not attend in person were enrolled. These patients received 6 months of structured telemedicine from bilingual pharmacists comprising educational reminders, biweekly counseling, and remote INR review with protocolized dosing. Time in Therapeutic Range (TTR) was the principal outcome measure. RESULTS: Mean TTR was 62.8% ± 18.1% and medication adherence was 83.5%. Out of 200 patients, 97 patients (48.5%) achieved TTR ≥ 65%. Overall complications occurred in 20 patients (10.0%). All bleeding events (BARC 1-3), the left atrial thrombus, and the stuck prosthetic valve occurred exclusively in the TTR < 65% group. Adequate control was associated with greater on-schedule INR testing (76.3% vs. 57.3%, p = 0.004) and less long-distance laboratory travel (36.1% vs. 63.1%, p < 0.001). CONCLUSION: Native-language, pharmacist-led telemedicine is a feasible model for warfarin management in geographically and linguistically isolated populations and may be scalable to other resource-limited, conflict-affected settings.