Deep Vein Thrombosis and Medical Negligence
Posted on 9th January 2021 at 10:47
Deep Thrombosis Claims
Deep Vein Thrombosis
A deep vein thrombosis, or DVT for short, is a blood clot that forms within a deep vein. It usually occurs in the leg. Although it mainly occurs in the legs, a DVT can also develop in the upper limbs, pelvis or abdomen. This happens in around 4-10% of cases and is linked to severe underlying diseases such as cancer.
There has been a lot of publicity in recent years regarding people suffering from DVT after long flights, but the earliest case of DVT was recognised around 600–900 BC. Another very early documented case is thought to have occurred in the 13th century, in the leg of a 20-year-old male.
Approximately 1 in 1000 adults per year will suffer a deep vein thrombosis. A DVT in children is very rare, affecting around 1 in 100,000 children.
The cause behind a DVT is complicated but there are basically three factors at play which increase your likelihood of having a DVT.
Hypercoagulability – in layman’s terms this is abnormal blood clotting. Basically, something is making the blood “stickier” and causing it to form clumps i.e. clots. Causes of this can be malignancy (cancer), surgery, trauma, taking the oral contraceptive pill or clotting abnormalities (something you may have been born which) such as thrombophilia.
Venous stasis – this is slow blood flow in the legs. Causes of venous stasis include immobility e.g. not moving much after surgery or injury, long periods of bed rest or (as referred to earlier, a long flight or drive). Pregnancy and heart failure can also increase your risk of venous stasis. However, it should be noted that the risk of developing a DVT from a long-distance flight is very small – statistically 0.01-0.04% for the general population.
Trauma – injury to the veins caused by inflammation or a previous thrombosis.
In the 1700s, a deep vein thrombosis in pregnant women was called “milk leg” as it was thought milk was building up in the leg. The recommended treatment was breastfeeding to alleviate the pressure in the leg!
Doctors use something called ‘differential diagnoses’ to work out what is wrong with you. Based on your symptoms and history, doctors may have a list of possible causes and whittle it down using blood tests and diagnostic tools such as x-ray, ultrasound, MRI etc. A DVT can produce similar symptoms to a musculoskeletal injury, a Baker’s cyst (a swelling behind the knee causing pain and inflammation) rupture or cellulitis (bacterial skin infection causing swelling, inflammation and redness).
Symptoms of a DVT
Around half of people with a deep vein thrombosis will have no symptoms. For others, symptoms include pain, swelling, redness or discolouration, increased temperature of symptomatic leg – it will feel warm to the touch and/or there may be swelling of surface veins.
Pulmonary embolism and post thrombotic syndrome are two of the most common complications of a deep vein thrombosis.
A pulmonary embolism is when a piece of the blood clot breaks off and travels to your lungs. It can block the flow of blood to your lungs and in some cases this can be fatal. If the clot is very small, you may not notice any symptoms but if the clot is large enough, you may experience shortness of breath, feeling dizzy or faint, chest pain, a rapid pulse and/or coughing up blood. The clot can cause your lungs to collapse and cause heart failure, which may result in death. 1 in 10 people with an untreated deep vein thrombosis will go on to develop a pulmonary embolism. A pulmonary embolism is a medical emergency and if you have any of the above symptoms or suspect you may have a PE, you should seek immediate medical attention.
Post thrombotic syndrome can occur as a long-term complication of a deep vein thrombosis. Symptoms include aching or cramping pain in the affected leg, heaviness, tingling, itching, swelling, varicose veins, brownish or reddish skin discolouration and an ulcer (an open sore). 20-40% of people with a history of deep vein thrombosis will suffer from post thrombotic syndrome.
Firstly, a doctor will take a detailed medical history from you. This will include your symptoms, when they started, what you were doing when they started etc. You will be asked about your past medical history – what medical conditions do you suffer from? Has anything like this happened before? You will be asked about family history and what medical conditions run in your family. You will be asked about your social history – occupation (this is important as some occupations are more at risk than others), your diet, lifestyle, how much you drink. You will also be asked about allergies and what drugs (prescription, over-the-counter or illicit) you currently or have recently taken, again important when diagnosing medical conditions.
The most important questions to ask a patient with a suspected deep vein thrombosis include is whether both legs are affected or just one? Is the patient pregnant? Is the patient mobile i.e. can they walk around? Has there been any recent trauma or injury? Any pitting? (Pitting is when you press the leg and an imprint/dimple is left visible. This is a sign of oedema). Any pain? Any skin changes?
Once a thorough history has been taken, you will be given a blood test called a D-dimer. It looks for fragments of a protein in your blood which will be present if you have a blood clot. If the result comes back negative, then it’s unlikely you have a deep vein thrombosis.
If the result comes back positive, you will have an ultrasound of your leg to look for a clot. This uses sound waves to look at your blood as it flows through the blood vessels in your leg. Duplex ultrasound successfully identifies 95% of deep vein thromboses that occur in the large veins above the knee.
If the ultrasound is negative, yet the patient’s symptoms are severe or a DVT is strongly suspected, the next step is either a venogram (venography) or magnetic resonance imaging (MRI). Sometimes the ultrasound is negative because there is a clot in a vein in the pelvis, hidden from the ultrasound.
Preventing a Deep Vein Thrombosis
Whilst in hospital, a risk assessment is usually carried out. This is to look at your risk of getting a deep vein thrombosis and ways in which it can be prevented.
You will be encouraged to stay hydrated. You can do this by drinking plenty of fluids or, if you’re unable to, you will be given intravenous (a drip going directly into your vein) fluids to stop you becoming dehydrated.
You may be given drugs called “anticoagulants”. This medication thins your blood, and stops it becoming sticky reducing the risk of clots.
To reduce venous stasis, clinicians recommend that you keep moving. If you’re on a long flight, do some calf exercises or take a walk in the aisle every so often. Avoid drinking alcohol or caffeine when flying, stick to water or fruit juice.
If you’re on a long drive, stop at a service station or lay-by every so often to get out and stretch your legs. People on bed-rest or having surgery should wear compression stockings or a compression device. Compression stockings are worn on the lower limbs (feet, ankles and legs) and fit tightly. They encourage your blood to flow more quickly around your body. A compression device works in a similar way to compression stockings, inflating and squeezing your legs at regular intervals to keep the blood moving.
If you have a confirmed deep vein thrombosis, you will be given anti-coagulation therapy, including perhaps Warfarin.
Anticoagulants can stop the clot from getting bigger or breaking off and becoming lodged in another part of your bloodstream such as the lungs (pulmonary embolism).
Although people call them ‘blood thinners’ they don’t actually thin your blood. They alter proteins within the blood meaning it can’t clot so easily.
It is important that doctors discuss the advantages and disadvantages of Warfarin before starting treatment. Warfarin can cause bleeding and patients should be aware of the signs and symptoms of bleeding. A blood clotting test (called an INR) will need to be carried out on a regular basis to monitor the patient’s blood clotting. Patients should avoid foods containing large amounts of vitamin K such as spinach and broccoli as this can interfere with Warfarin. Warfarin can also interfere with lots of different other medications and your doctor or pharmacist should provide you with a list of what to avoid.
An inferior vena cava (a large vein) filter is a medical device that may be inserted in active bleeding, or when anticoagulant fails, to minimise the risk of a pulmonary embolism. The filter is used to trap any clots in your vein before they can travel to your lungs and heart.
Your doctor is likely to advise you to try to start walking as soon as possible after having a deep vein thrombosis. You may be advised to wear a compression stocking on the affected leg for up to two years afterwards as this may ease your symptoms and prevent the occurrence of post-thrombotic syndrome.
Medical Negligence and Deep Vein Thrombosis
Can a doctor be guilty of medical negligence in relation to failure to diagnose or treat a deep vein thrombosis? If a doctor or medical practitioner fails to diagnose a blood clot, fails to take appropriate preventative measures or fails to administer anticoagulant (blood thinning) drugs or identify the risks once a blood clot is diagnosed, then you may have a potential claim for medical negligence. The same applies to a pulmonary embolism. It is important to diagnose and treat a pulmonary embolism early, and failure to do so can have very serious consequences.
To speak to a medical negligence solicitor in confidence and free of charge, simply call 01925 937070 or email Diane Massey on [email protected] for expert assistance. We offer ‘no win, no fee’ for all medical negligence cases we accept. Strict time limits apply in making a medical negligence claim so make sure you obtain legal advice as soon as possible.
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