Treatment outcome of deep veinous thrombosis and its predictors among hospitalized patients at selected tertiary hospitals in Ethiopia: a prospective cohort study

Abstract

: Deep Venous Thrombosis (DVT) is a common clinical problem that is associated with substantial morbidity and mortality. Knowledge on the global burden of DVT recurrence is deficient in Africa, including Ethiopia. Accurate data are needed to evaluate the burden of VTE in Africa to design effective preventive and treatment strategies. Objective: To assess treatment outcome of deep venous thrombosis and its predictors among hospitalized patients at selected tertiary care setting in Ethiopia Methods: A prospective cohort study was conducted among hospitalized DVT patients at Jimma University Medical Center and St. Paul’s Hospital Millennium Medical College. Patient specific data was collected using structured data collection tool prepared from literatures. Data was entered using EpiData version 4.2 and analyzed using statistical software package, SPSS version 21.0. To identify independent predictors of DVT recurrence, multiple stepwise backward cox regression analysis was done. Data was presented in the form of charts, tables and graphs accordingly. Statistical significance was considered at p-value <0.05. Patient’s written informed consent was obtained after explaining the purpose of the study. Patients were informed about confidentiality of the information obtained. Results: A total of 129 participants included into study; of which 65.1% were females. The mean± SD age of patients was 38.63 ±17.67 years. About 34(26.4%) of patients developed recurrent VTE within 3 months of study. Type of recurrent event was DVT in 28 patients (82.40%) and the rest admitted with pulmonary embolism. The overall incidence density was 2.99 per 1000 person-days. The mean ± SD survival time to DVT recurrence was 42.03±22.371 days. Completes resolution was seen for about 4.7% of patients. Age between 30 to 50 years [AHR, 3.545; 95 % CI, 1.216, 10.338; p=0.020], age ≥ 50 years [AHR, 5.566; 95 % CI, 1.587, 19.518;p=0.007], alcohol use( AHR, 1.71; 95 % CI, 1.096, 2.662; p=0.018)], prior history of surgery [ AHR, 6.218; 95% CI, 1.540, 25.104; p=0.010], pregnancy [AHR, 2.0911; 95% CI, 1.046, 4.179; p=0.037], diabetes mellitus comorbidity [AHR, 8.048; 95% CI, 2.494, 25.966; P<0.001], not achieve target aPTT within 24hrs of heparin initiation [AHR, 1.129; 95% CI, 1.020, 10.600; p=0.011], proximal site involvement [ AHR, 5.937; 95% CI, 1.300, 27.110; p=0.022] were independent predictors of DVT recurrence. Conclusion and Recommendations: In general, DVT recurrence rate was higher in the current study, which is even complicated with pulmonary embolism as well as death during the follow up period. Thus, efforts are needed to prevent DVT and reduce the development of recurrences.