Delays in the management of venous thromboembolism

Delays in diagnosis and treatment of venous thromboembolism in a developing country setting

It is important to promptly suspect, confirm the diagnosis of venous thrombosis to avoid or reduce the risk of venous thrombosis and its complications. Every physician would generally make an effort to achieve the early anticoagulation in these patients as soon as the diagnosis is confirmed. In a recent paper published from the Iran it was observed that the delay in the diagnosis and treatment is related to the delayed presentation of the patient to the clinics and hospitals. Probably it is the same reason in many other countries where the general awareness of the problem is not there in the public and peripheral medical centers.


Tuberk Toraks. 2013 Jun;61(2):96-102. Rahimi-Rad MH, Rahimi-Rad S, Zarrin S. Source Department of Respiratory Medicine, Faculty of Medicine, Urmia University, Urmia, Iran. rahimirad@hotmail.com.Abstract : Introduction: Rapid diagnosis and treatment of deep vein thrombosis and pulmonary thromboembolism reduce mortality and morbidity. The aim of this study is to investigate delays in treatment of deep vein thrombosis and pulmonary thromboembolism and related factor in a developing country. Materials and Methods: We prospectively investigated 353 patients with diagnosis deep vein thrombosis and/or pulmonary thromboembolism in Urmia, Iran. We recorded dates of symptom onset, initial visit by a clinician, initiation of treatment, and confirmation of diagnosis. We also analyzed relation with some factors. Results: The mean interval from symptoms onset to initiation of treatment was 4.70 days, 89% of this interval was between onset of symptoms to first medical evaluation (mean= 4.19 days). Mean time from onset of symptoms to confirmation of diagnosis was 6.29 days. Of 353 patients with venous thromboembolism 185 (52.4%) visited by a physician within two days of onset of symptoms and 168 (47.6%) patients after two days. Factors that was associated with earlier seeking with p value < 0.05 were pulmonary thromboembolism patients earlier than deep veinthrombosis, higher education, recent surgery, presence of cast, entire leg swelling. There was no association between age, gender, number of symptoms, and presence familial history of venous thromboembolism (all p value > 0.05). The delays time from first visit to final diagnosis was significantly shorter in patients with high probability score. Conclusion: Most patients with venous thromboembolism received anti-coagulation and diagnosis with delay. The main cause of delay is related to patient's delays. There is a need to improve people awareness about venous-thromboembolism and to develop strategies to reduce delays.