Abstract:
Background: HIV-infected patients are at an increased risk of developing venous thromboembolism (VTE), and minimal
data are available to describe the need for extended treatment. Objective: To evaluate the frequency of and determine
predictive risk factors for extended anticoagulation of VTE in HIV-infected patients in rural, western Kenya. Methods:
A retrospective chart review was conducted at the Anticoagulation Monitoring Service affiliated with Moi Teaching and
Referral Hospital and the Academic Model Providing Access to Healthcare. Data were collected on patients who were
HIV-infected and receiving anticoagulation for lower-limb deep vein thrombosis. The need for extended anticoagulation,
defined as receiving ≥7 months of warfarin therapy, was established based on patient symptoms or Doppler ultrasound–
confirmed diagnosis. Evaluation of the secondary outcomes utilized a univariate analysis to identify risk factors associated
with extended anticoagulation. Results: A total of 71 patients were included in the analysis; 27 patients (38%) required
extended anticoagulation. The univariate analysis showed a statistically significant association between the need for
extended anticoagulation and achieving a therapeutic international normalized ratio within 21 days in both the unadjusted
and adjusted analysis. Patients with a history of opportunistic infections required an extended duration of anticoagulation
in the adjusted analysis: odds ratio = 3.42; 95% CI = 1.04-11.32; P = 0.04. Conclusions: This study shows that there may
be a need for increased duration of anticoagulation in HIV-infected patients, with a need to address the issue of long-term
management. Guideline recommendations are needed to address the complexity of treatment issues in this population.
