Thrombosis & Blood Clot Medical Negligence Compensation Solicitor
The National Health Service (NHS) pays out over 100,000,000 every year in medical negligence compensation claims as a result of failing to diagnose thrombosis or prevent avoidable life threatening blood clots. There are national guidelines that should be followed by healthcare professionals including consultants, doctors and nurses and failure to follow these well-established protocols is likely to be considered as negligence. A medical negligence solicitor who is instructed to take legal action will intially scrutinise the medical notes to establish whether there has been a lapse of protocol. The guidelines indicate that a risk assesment should be carried out to assess risk of thrombosis including the risk of pulmonary embolism and deep vein thrombosis which is also known as DVT
SOLICITORS HELPLINE 0844 332 0220
The NHS Litigation Authority has indicated that it is anticipated that more than 25,000 people a year would die from a blood clot because of failure to follow national guidelines and less than adequate identification and prevention techniques. A head of the NHS Litigation Authority has stated :-
“The human cost of this preventable condition is devastating but it’s only now that the crippling financial cost of poor treatment has been laid bare”
SOLICITORS HELPLINE 0844 332 0220
Whilst the NHS have more than adequate prevention guidelines in place, few hospitals treat this issue as a medical emergency and fail to meet mandatory prevention goals. Hospitals are expected to carry out risk assessments on patients with a minimum goal of 90% of patients being screened for potential development of thrombosis or a blood clot however less than a fifth of all hospitals achieve the minimum targets. In real terms this means 4.5 million patients a year miss out on potentially life-saving assessments that could prevent clots and are put at severe risk of permanent physical disability, brain damage and death. Many patients have all of the classic symptoms however untrained or negligent medical staff nevertheless miss clear indicators of a thrombosis. Measures necessary to reduce risk may be as simple and cost effective as compression stockings and blood-thinning drugs to reduce the risk of clots in high-risk patients, including the elderly and those having surgery.
SOLICITORS HELPLINE 0844 332 0220
Medical Negligence Solicitors
Our medical negligence solicitors are specialists and they are members of the Solicitors Regulation Authority panel of clincal negligence experts. In suitable cases they may be able to offer public funding formerley known as legal aid and they will also deal with cases using the no win no fee scheme. If you would like free advice without further obligation just call our helpline or email our offices. A medical negligence solicitor will speak to you and advise on liability and the estimated value of your compensation claim.
Deep Vein Thrombosis and Pulmonary Embolism
A deep vein thrombosis is a clotting condition of the lower legs. It is estimated that about one in a thousand persons will develop a DVT. It is a cause of death in women throughout the world. The clot begins spontaneously, usually in the veins around the ankle. The clot spreads upward to involve occasionally the femoral vein or popliteal vein. Some DVTs travel far up the deep veins, into the upper leg or pelvis. This is when DVTs are most dangerous because they can break off and cause a pulmonary embolism or PE, a serious condition in which the blood clot has passed into the lungs. In such cases, the lungs are starved of oxygen and the patient may die.
Sometimes the veins of the arms can be affected in deep vein thrombosis but it only occurs in patients with Paget-Shrotter disease—a hereditary disease that leads to excessive clotting in unusual places. These people need to be on chronic anticoagulant therapy like Coumadin to prevent recurrent clots.
DVTs occur because of a cluster of reasons called Virchow’s triad. The triad includes have poor flow of blood in the lungs, such as when you’re stuck on an airplane and can’t move your legs around. You also often have damaged vein walls that build blood clots on them easily. The last part of the triad is an increased chance of clotting, which comes in diseases like cancer, obesity, pregnancy, and estrogen-containing birth control. Inflammatory conditions, certain drugs, history of stroke, heart failure and kidney disease can all contribute to getting a DVT. Patients who have had surgery on their pelvis, back or lower legs are at greater risk of getting a DVT. For this reason, compression devices or compression stockings are used to prevent a DVT from occurring.
Some patients have no symptoms with their DVTs but most will have one lower leg more swollen than another, redness of the leg, and pain in the back of the leg when pressing on the venous tract. The doctor will further prove the condition of DVT by doing test called a Homan’s sign. This is when the doctor lifts the foot at the ankle (dorsiflexes it) and tries to elicit excess pain in the back of the leg. Increased pain in the back of the leg on dorsiflexion means a positive Homan’s sign.
If a DVT is not treated, a PE can occur fifteen percent of the time. About 3 percent of people with a DVT go on to have a fatal PE in the end. If people have a DVT for a long time, they can get a condition known as post-thrombotic syndrome. Patients with this have a swollen lower leg, an associated skin rash and chronic pain and discomfort in the legs. This is a rare complication.
Doctors try to diagnose DVTs in many ways. The first is a d-dimer test, which is a blood test that identifies products of clots and indicates that clotting is happening somewhere in the body. It doesn’t say why the person has the DVT or even that they definitely have a DVT.
More definitive testing involves doing a Doppler ultrasound of the legs, which can show what is happening to the blood flow within the veins. This can be completely definitive in and of itself. Another test that is less often done is a venous venogram of the lower extremities. This is a dye and x-ray study of the lower extremities that can tell the outline of the veins and can actually see the clots if present.
Doctors need to treat DVTs primarily because of the risk of developing a PE. Higher DVTs have a greater chance of developing a PE, so these might be treated with TPA or tissue plasminogen activator. This is a blood clot busting drug that fortunately has the capacity to break up clots quickly. Other more common treatments include the use of intravenous heparin and oral Coumadin. Both are blood thinners that keep the clot from going so it can regress on its own. The Coumadin eventually reaches therapeutic levels and the IV heparin can be discontinued, leaving the person on oral Coumadin for up to three months or more.
Patients with recurrent DVTs or a PE that is recurrent can have an additional treatment. Doctors can put in a vena cava filter that blocks any broken blood clots from going off to the lungs and causing a PE.
If a person unfortunately gets a pulmonary embolism, he or she may die instantly if the clot that travels to the lungs is particularly large. It is estimated that fifteen percent of those who die of a sudden death do so because of a large PE. People with smaller blood clots will feel shortness of breath, anxious, and have pain in the chest which is worse on inhalation. Doctors might not hear anything with the stethoscope but there is the possibility of a “friction rub” or extra sound heard on inspiration and expiration in certain areas of the lungs. There is also a risk for low oxygen noted in the system and the finding of rapid respirations and possibly blue lips.
A doctor suspicious for a PE can do a d-dimer test to see if there is active blood clotting in the system. This can be followed by a dye study in which dye is injected into a peripheral vein and a CT scan of the chest is performed. More rarely, an MRI scan of the chest can be done.
If a PE is noted, the doctor can give the patient TPA or tissue plasminogen activator to break up a severe or large clot. In less severe patients, the patient is given IV heparin and Coumadin together until the Coumadin is active enough. It is then that the IV heparin is stopped and, if the patient is stable, he or she is given only Coumadin, sent home and left on Coumadin for a minimum of three months. Patients with known clotting disorders or recurrent DVTs or PEs will need to be on Coumadin longer—perhaps for the rest of their life.