Delayed diagnosis and treatment of deep vein thrombosis - an underrecognized factor for its related outcomes?

BACKGROUND: Rapid diagnosis and treatment of deep vein thrombosis (DVT) reduce morbidity and mortality. OBJECTIVE: This study aimed to investigate the time to diagnostic imaging, time to treatment, and outcomes associated with the delayed treatment of DVT. METHODS: We retrospectively investigated 110 patients who were diagnosed with proximal DVT in outpatient clinics in a single academic centre in Thailand from January 2019 to September 2020. We recorded demographic data, clinical presentations, time to diagnostic imaging (ultrasound of the legs), and time to treatment. We recorded outcomes, including death, pulmonary embolism (PE), recurrent DVT, and thrombus resolution 3 months after the diagnosis of DVT. RESULTS: Of all 110 patients, 42 (38.2%) were male. Median age (IQR) was 68.5 (58-80) years. The median (IQR) time to diagnostic imaging was 7 days (2-27). The median (IQR) interval from the first OPD visit to the initiation of treatment was 14 days (3-31). The delayed diagnosis (more than 7 days from the first clinic visit to diagnostic imaging) was observed in 54 (49%) patients with DVT. The delay in treatment (more than 7 days from the first clinic visit to treatment) was observed in 67 (60.9%) patients. The maximum time to treatment was 160 days. Death and PE occurred in 9% and 33% of patients with delayed treatment, while they occurred in 5% and 20% of those with early treatment, respectively. No recurrent DVT was observed. Among 25 patients who had follow-up imaging, residual thrombus occurred in 71% of patients with delayed treatment and 63% of those with early treatment. CONCLUSION: Half of the DVT patients had delays in diagnosis and treatment of proximal DVT. The routine request option was associated with a delayed diagnosis. The importance of early diagnosis and treatment of DVT should be raised among physicians, and improvement strategies are warranted.