title: Venous Thromboembolism Requiring Extended Anticoagulation Among HIV-Infected Patients in a Rural, Resource-Constrained Setting in Western Kenya.
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.
authors.affiliation: 1 Moi Teaching and Referral Hospital, Eldoret, Kenya.|2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Kanyi
authors.affiliation: 2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|3 Purdue University College of Pharmacy, West Lafayette, IN, USA.|4 Moi University School of Health Sciences, Eldoret, Kenya.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Karwa
authors.affiliation: 2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|3 Purdue University College of Pharmacy, West Lafayette, IN, USA.|4 Moi University School of Health Sciences, Eldoret, Kenya.
authors.forename: Sonak Dinesh
authors.initials: SD
authors.lastname: Pastakia
authors.affiliation: 1 Moi Teaching and Referral Hospital, Eldoret, Kenya.|2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Imran
authors.initials: I
authors.lastname: Manji
authors.affiliation: 1 Moi Teaching and Referral Hospital, Eldoret, Kenya.|2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Simon
authors.initials: S
authors.lastname: Manyara
authors.affiliation: 2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Collins
authors.initials: C
authors.lastname: Saina
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015276:Health Care Rationing / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D019934:International Normalized Ratio; D007630:Kenya; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D013997:Time Factors; D018608:Ultrasonography, Doppler; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: HIV; Sub-Saharan Africa; extended anticoagulation; venous thromboembolism; warfarin