Background: The diagnosis of deep vein thrombosis (DVT) requires an etiological research of HIV infection. The objective was to identify the characteristics of patients with DVT of limbs without other risk factors in our context. Methods: We performed a comparative retrospective study from January 2005 to December 2012. We identified 162 cases of patients hospitalized in Medicine Department of Institute of Cardiology of Abidjan with 124 HIV-negative and 38 HIV positive patients. Results: DVT is more common in HIV positive young patients (57.8 ± 15.6 years vs 39.3 ± 10.6 years, p = 0.0001). The traditional risk factors were found in HIV negative patients. HIV positive patients had no predisposing factor for thrombosis. The ankle-femoral popliteal location (29% vs 73.7% p = 0.05) was most frequent in HIV positive patients. There was no significant difference in anticoagulant therapy: UFH (60.5% vs 52.6%; p > 0 . 05), LMWH (20.2% vs 7.9%; p > 0 . 05), AVK relay (99.2% vs 100%; p > 0 . 05) and general measures (elevation MI). (70.2% vs 65.8%; p > 0 . 05). None of the patients in both groups had worn stockings in hospitalization. The stockings were prescribed on discharge (70% vs 64.7%; p > 0 . 05). Conclusion: DVT may be the mode of revelation of HIV infection. The etiological research with HIV infection should be systematic in young patients suffering from DVT in the absence of risk factors of thrombosis.
Deep vein thrombosis of lower limbs is a potentially serious and disabling pathology by the complications. It can generate either abruptly via pulmonary embolism or secondarily in the long term via post thrombotic syndrome. Every year in France, it affects 50,000 to 100,000 people [
The objective of this study was to compare the clinical, etiologic, and therapeutic characteristics of patients with deep vein thrombosis of lower limbs by HIV status.
From January 2005 to December 2012, 202 files of patients with deep vein thrombosis of the lower limbs were hospitalized in the Department of Medicine of the Abidjan Heart Institute. Their file included a clinical examination, a standard paraclinical assessment including HIV serology.
We carried out a comparative analytical retrospective study over a period of 7 years. These are the files from January 2005 to December 2012
The inclusion criteria were the presence of deep vein thrombosis documented by ultrasonography, regardless of location during the course of our study. Concerned the records of patients hospitalized in Medicine at the institute of cardiology of Abidjan. The study excluded 40 incomplete files that did not include venous duplex ultrasound results or HIV serology (19.8%). A total of 162 patients including 124 HIV-negative (VN) patients and 38 HIV-positive patients (PV) were included.
We read all the observations to identify the different characteristics of the patients under study. The data was collected on a survey sheet.
In the clinical assessment, the clinical risk factors for thrombosis (obesity, anemia, prolonged bed rest, gynecological obstetric factors and orthopedic surgery) have been systematically sought. He was also researched the family history of deep vein thrombosis of lower limbs and pulmonary embolism.
A clinical examination including blood pressure (BP), heart rate (HR), weight, height, cardiovascular, pleuropulmonary, abdominopelvic, spleno-ganglionic, urogenital, musculoskeletal and mucocutaneous note.
Complementary examinations included a frontal chest X-ray, an electrocardiogram and an abdominopelvic ultrasound. An abdominopelvic CT scan and the PSA level according to the clinical context (anomaly on the abdominal and / or pelvic ultrasound and abnormal prostate).
The biological assessment noted the results of the blood count, platelet count, sedimentation rate, C reactive protein, TCK, TP, CD4 count (in case of positive HIV serology).
The search for thrombophilia markers (protein deficiency C and S, antithrombin III), factor 5 Leiden, circulating anticoagulants, antiphospholipids, fibrinogen level, factor Xa) was not achieved because of lack of technical platform.
We have identified the delay in initiating anticoagulant therapy following confirmatory venous duplex and biological assessments of deep vein thrombosis.
The nature and dosage of the anticoagulation, the frequency of the monitoring elements (TCK, platelets and INR) and the relay by antivitamin K were noted.
Data entry and processing was done using Word, Excel software. The simple description of the sample was made possible by averaging and standard deviation calculations. The Chi-square test was used for the comparison of the percentages and the Student’s test for the averages with a risk of error fixed at 5%. Fisher’s exact test was used for small numbers.
Of the 162 patients, 38 HIV-positive cases were diagnosed during the etiological review. The age difference was significant between the groups (57.8 ± 15.6 years vs. 39.3 ± 10.6, p = 0.0001). Suro-poplitofemoral localization was significantly predominant in the HIV-positive group (29% vs 73.7% p < 0.05). On the other hand, the suro-popliteo-femoro-iliac localization was significantly predominant in the HIV-negative group (61.3% vs 23.7%, p < 0.05). There was no significant difference in popliteal location (4.8% vs 2.6%, p > 0.05) and in the achievement of right lower limbs (21.8% vs 5.3%; p > 0.05), left lower limbs (46% vs 36.8%, p > 0.05) or bilateral lower limbs (4.8% vs 2.6%, p > 0.05) (
Traditional risk factors such as obesity, anemia, prolonged bed rest, gynecological obstetric factors and orthopedic surgery have been found in HIV-negative patients. HIV-positive patients had no thrombosis-promoting factors (
There were no significant differences in anticoagulant therapy: unfractionated heparin (60.5% vs. 52.6%, p > 0.05), heparin of low molecular weight (20.2% vs. 7.9%, p > 0.05), relays by AVK (99.2% vs 100%, p > 0.05) and the general measures: elevation of lower limbs (70.2% vs 65.8%, p > 0.05) (
Suro popliteo femoral | 36 (29%) | 28 (76.7%) | <0.05 |
---|---|---|---|
Suro popliteo femoro-iliac | 76 (61.3%) | 9 (23.7%) | <0.05 |
Popliteal | 12 (9.7%) | 1 (2.6%) | >0.0 |
HIV Negatives | HIV Positives | p | |
---|---|---|---|
n = 124 | N = 38 | ||
Age (years) | 57.8 ± 15.6 | 39.3 ± 10.6 | 0.0001 |
M | 64 (51.6%) | 21 (55.3%) | >0.05 |
F | 60 (48.4%) | 17 (44.7%) | |
Risk factors | |||
Anemia | 34 (42.7%) | 0 | <0.01 |
Obesity | 24 (19.3%) | 0 | <0.01 |
Extended bed rest | 19 (15.3%) | 0 | >0.05 |
HTA | 11 (8.9%) | 0 | >0.05 |
Gynecological obstetrics | 2 (1.6%) | 0 | <0.01 |
Taking oestroprogestatives | 5 | 0 | |
Myoma | 3 | 0 | |
Caesarean | 2 | 0 | |
Pregnancy | 1 | 0 | |
Cancer | 5 (4%) | 0 | >0.05 |
Prostate | 3 | 0 | |
Within | 1 | 0 | |
Uterus | 1 | 0 | |
Tobacco | 3 (3.2%) | 0 | >0.05 |
Orthopedic surgery | 11 (8.9%) | 0 | >0.05 |
Other |
Inpatient Treatment | HIV Negatives | HIV Positives | p |
---|---|---|---|
n = 124 | n = 38 | ||
Relay by AVK | 84 | 20 | NS |
Heparin Unfractionated | 123 | 38 | NS |
Heparin of Low Molecular Weight | 25 | 3 | NS |
Stockings | 0 | 0 | |
Heparin Association―AVK | 19 | 7 | NS |
Elevation of lower limbs | 75 | 31 | NS |
AVK: Antivitamin K; MI: Inferior Members.
TCK was daily in patients who received standard heparin and the platelet count was biweekly. The administration of unfractionated heparin was stopped on average after 4 days when the INR was between 2 and 3. The INR control was performed every 48 hours. Hemorrhagic complications and heparin-induced thrombocytopenia were not observed in both groups. None of the patients in both groups had compression stockings in hospital. The lows were prescribed at discharge (70% vs. 64.7%, p > 0.05).
In this study of patients with deep vein thrombosis of lower limbs, the 38 positive HIV cases were discovered incidentally. These patients were in good general condition with no particular history of CD4 levels within normal limits. They had no opportunistic affections or antiretroviral treatment. HIV infection is known to be a provider of deep vein thrombosis [
In general, the occurrence of deep vein thrombosis is multifactorial in the general population [
Antiretroviral therapy, especially anti-proteases, is associated with the occurrence of thrombotic events [
The anticoagulation strategy is identical in both groups of patients. Unfractionated heparin was the most used anticoagulant in both groups. Heparin of low molecular weight has shown its effectiveness.
For the etiological research, we could not make the assessment of the thrombophilia because of the insufficient technical platform.
Like any retrospective study, we only use the complete files comprising venous Doppler lower limbs and serology HIV.
Deep vein thrombosis was the circumstance of discovery of HIV infection in patients in our study. These patients were young without any well-identified thrombosis-promoting factor in our work setting. The etiologic assessment for HIV infection should be systematic in young subjects with supra-popliteo femoral thrombosis in the absence of other factors promoting thrombosis, as well as the search for protein deficiency C and S and inflammatory status (sedimentation rate and C reactive protein).
Traore, F., Bamba, K.D., Koffi, F., Esaie, S.., Ncho-Mottoh, M.-P., Ngoran, Y.N.K. and Coulibaly, I. (2017) Prevalence of HIV in Hospitalized Patients with Venous Thrombosis of the Lower Limbs to the Abidjan Cardiological Institute. World Journal of Cardiovascular Diseases, 7, 435-441. https://doi.org/10.4236/wjcd.2017.712042