Deep vein thrombosis in the era of high HIV and TB prevalence: a prospective review of its diagnosis and treatment in a quaternary care centre
Date
2017
Authors
Hodkinson, Katherine Elizabeth
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Abstract
Background
Venous thromboembolic disease (VTE) is a leading cause of morbidity and mortality worldwide.
Human immunodeficiency virus (HIV) and tuberculosis (TB) infections have an aetiological
association with VTE. Implementation of national HIV and TB programs in South Africa have
changed the burden of these two conditions with resultant effects on VTE prevalence.
Furthermore, with the increased use of direct oral anticoagulants (DOACs), baseline thrombosis
data is needed in order to evaluate the impact of these new agents.
Objectives
To determine the real-life baseline VTE characteristics in a pre-DOAC era and to document the
association of HIV and TB infections with VTE.
Methods
This is a single centre prospective cohort study performed in a quaternary care centre at the
Charlotte Maxeke Johannesburg Academic Hospital (CMAJH), Gauteng, South Africa. Key
inclusion criteria included a signed informed consent by adults (≥ 18 years) with a new episode
of thrombosis. Procedures included physical examination, thrombosis risk factor assessment,
duplex doppler examination, thrombotic screen tests, inpatient treatment and outpatient followup.
Results
Ninety-nine participants with confirmed thrombosis met the inclusion criteria. Participants were
predominantly black (80%) and female (65%) with a median age of 46 (38-57) years. The HIV
and TB prevalence were 53% and 21% respectively. The most common thrombosis risk factors
were TB infection (17%) and malignancies (14%). The thrombotic screen assays had a low
diagnostic yield. The median time to target international normalized ratio (INR) during
hospitalization was 5.5 (4.0-7.0) days and the median duration of hospitalization was 9 (7-11)
days. The overall mortality in the cohort at three months post hospitalization was 12%.
Conclusion
This prospective study provides real-life data of thrombosis diagnosis and management at a
quaternary public healthcare facility. This data provides a valuable baseline against which the
impact of new DOAC anticoagulants can be assessed.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Master
of Medicine (Haematology).
Johannesburg, 2017.
Keywords
Venous Thromboembolic Disease