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There are 1.2 million strokes in India each year, more than in Europe and the United States combined, high risk, blood clots, no comprehensive, anywhere in the world.

Among patients at highest risk of stroke are 2.4 million Indian adolescents and young adults who suffer from rheumatic heart disease, and 7.5 million adults who suffer from atrial fibrillation. These conditions have a high risk of developing blood clots in the heart that can then travel to the brain with catastrophic results. Anticoagulation lowers stroke risk in these conditions by 65-85%, but is underutilized in India because it requires frequent and cumbersome monitoring.

There are enormous challenges to achieving effective anticoagulation in resource-poor settings, including limited patient literacy, unavailability of quality blood-testing laboratories, scarcity of knowledgeable physicians, and high costs.

In addition, nurse- or pharmacist-run clinics using dosing algorithms are the standard of care in high-income countries, but these are practically non-existent in India. Moreover, the algorithms that are currently available are derived from western populations and may be inadequate in non-western, poorer countries, as body weight, dietary habits, and genetic make-up all impact required dosage.

There are currently no comprehensive anticoagulation programs available in India. Further, we are unaware of any such program—anywhere in the world—that targets low-resource, low-literacy settings.

A comprehensive program addressing the numerous barriers to high-quality anticoagulation in low-income, low-literacy populations is urgently needed.