Deep Venous Thrombosis & Pulmonary Embolisms

A deep venous thrombosis is a blood clot that forms most often in the veins of the leg and sometimes in the arms. It is often referred to as a “DVT.” Regardless of where the thrombosis/blood clot develops it is a serious medical condition because it may lead to a pulmonary embolism (“PE”). A pulmonary embolism occurs when a blood clot breaks loose in the vein and travels to the lungs where it can cause respiratory failure. This often leads to death. While anyone can develop a DVT and a pulmonary embolism, certain categories of individuals have been identified as having acquired and/or genetic risk factors that predispose them to the development of a DVT and hence a pulmonary embolism. Most people do not know whether they have a genetic predisposition to develop a DVT since there is normally no reason to routinely test for such genetic factors. On the other hand, certain acquired factors are readily apparent risk factors. Some of these acquired risk factors include:

1. Long-haul air travel
2. Obesity
3. Cigarette smoking
4. Oral contraceptives
5. Pregnancy
6. Postmenopausal hormone replacement
7. Surgery
8. Trauma
9. Cancer
10. Systemic arterial hypertension
11. Chronic obstructive pulmonary disease (COPD).

See Harrison’s Principles of Internal Medicine (16th ed. 2005) Chapter 244 Pulmonary Thromboembolism, p. 1561.

Doctors have developed certain measures that lessen the risks to individuals who are undergoing certain surgical procedures. These measures are referred to as “prophylactic measures.” For example, certain medication regimens are suggested for individuals undergoing: (1) high-risk general surgery; (2) thoracic surgery; (3) cancer surgery; (4) total hip and knee replacement surgery; (5) neurosurgery; and (6) brain tumor surgery. These regimens may include the administration of Warfarin (also known as Coumadin), unfractionated heparin, low-molecular weight heparin, graduated compression stockings and intermittent pneumatic compression devices. See Antithrombotic and Thrombolytic Therapy, Executive Summary, American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Ed. 2008).

Unfortunately there are times when, despite the presence of one or more risk factors, physicians perform one of the above listed surgeries without instituting recommended prophylactic measures. In such cases, a blood clot and a pulmonary embolism may develop and serious injury or death may occur. Under such circumstances the involved physicians may have been negligent in the care or treatment provided to the patient.

Of course, each case is fact specific and the discussion above reflects general rules and is not intended to provide either medical or legal advice. Medical questions should be discussed with your physician. If legal questions arise following an adverse outcome, then these questions should be answered by a qualified attorney. In some cases, filing a lawsuit may be necessary to obtain reasonable compensation for any medical negligence that may have occurred.