DVT Compensation

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Deep Vein Thrombosis

You may be eligible for medical negligence compensation if you have suffered a Pulmonary Embolism or Deep Vein Thrombosis (DVT) which was misdiagnosed or treated incorrectly. Call our legal team to find out about your legal rights.

A DVT is also called a deep vein thrombosis and is a blood clot that forms in the deepest veins of the legs or rarely, in the deepest veins of the upper arms.  You can have no or few symptoms but most people feel pain in the legs, associated with redness, warmth, engorgement of superficial veins and leg swelling.  While a DVT is painful, its biggest risk is that the blood clot can break off and cause a pulmonary embolism or PE. 

You get a DVT if you are older and have poor veins, lie down too much due to illness, a long travelling ride, have a clotting disorder, are a smoker and/or use birth controls. People who have had lower limb, pelvic or back surgery are a particular risk for a DVT.  If you have had a DVT for a long time or on a recurrent basis, you can get thrombotic syndrome, which results in permanent swelling, redness and a need for compression stockings at all times. 

The doctor can diagnose a deep vein thrombosis by checking a blood test called a D-dimer and by doing a Doppler ultrasound of the deep veins.  You can also have a dye test of the veins that shows the flow of blood through the veins and a plethysmography can also measure blood flow.   To evaluate a DVT, the doctor measures the thickness of both lower extremities to look to see if one is bigger than the other.  He or she can also palpate the tract of the vein to see if it is tender.  The doctor can also check for a positive Homan’s sign, which is increased pain on dorsiflexion (lifting up) at the level of the ankle.  

The doctor needs to take a careful history of a person with a possible DVT.  He or she may need to ask about smoking history, the use of hormonal contraception, recent long-trip flying, recent history of a miscarriage, hereditary propensity toward PE, a history of a hemophilia syndrome (hereditary thick blood) and other hereditary symptoms.   Travelers are at a special risk for DVTs if they do not wear compression stockings, are older, pregnant or obese.  The trick is to move around a lot during the flight or drive and to stay really hydrated.  Travelers who go by bus, plain, car and train are at equal risk.  If you have a disease called antiphospholipid syndrome or cancer, your risk goes way up. The DVT usually starts in the lower calf and grows bigger off the top so it can get big enough to go into the iliac veins or even the inferior vena cava.  Big DVTs make you at a much greater risk for a pulmonary embolism. 

Doctors do a d-dimer test if there is a suspicion of DVT.  This is done if the probability of DVT is low.  It is a test for a cross-linked fibrin degradation product found whenever blood clots are occurring. Other diseases can have a positive d-dimer test.  Doctors also do a CBC, Protime, APTT, fibrinogen, liver function studies, kidney function studies and electrolytes.

DVT prevention includes using compression stocking or graded progression devices in the hospital for all high risk patients.   Very high risk patients are injected with low dose heparin to prevent clotting.  Non-hospitalized patients should move around on airplanes and buses, and should take frequent breaks when riding on long car trips.  They should wear compression stockings and remain well hydrated throughout the trip and when they are sick and in bed for a long time.  Wearing compression stockings still causes a rate of up to 4 percent symptomatic DVTs in higher risk patients.  In those who have recurrent DVTs, Coumadin may be used or the patient may need an inferior vena cava filter placed to prevent the DVT from becoming a pulmonary embolism or PE.

The pulmonary embolism is the most severe complication of a deep vein thrombosis.  A DVT is turned into a pulmonary embolism (PE) when clots break off the lower extremities and pass up the vena cava into the lungs.  Large ones stay at the opening to each lung entrance and the result is sudden shortness of breath and often sudden death.  PEs can also be the result of bubbles of talcum, air or fat from other body parts.  Amniotic fluid emboli can occur in pregnancy and can cause a PE.  Situations like having cancer or being immobilized can increase the risk of PE.

Doctors (and you) can be suspicious of a PE if you have sudden shortness of breath, pain that is worse on inspiration, tachycardia (fast heart beat), low oxygen, blue lips, breathing fast and sometimes a very low blood pressure associated with sudden death. Doctors mildly suspicious of a PE will often do the d-dimer test and a test called a CT pulmonary angiography which shows missing areas of oxygenation in the lungs. 

If you have a PE and survive it, the doctors may use TPA or tissue plasminogen activator to break up the clot quickly as this is a medical emergency.  Severe cases can involve surgical intervention in the form of a pulmonary thrombectomy.  Doctors then start you on heparin and Coumadin simultaneously and stop the heparin when the Coumadin has built up in your system enough.  Then it is safe to go home on Coumadin for at least three months and longer if you have risk factors. 

The most major risk factor for PE is a proximal leg deep vein thrombosis or proximal DVT.  The pelvic vein can be involved, which increases the risk.  Up to 15 percent of DVTs go on to become PEs.  There are automatic alterations in the flow of the blood due to surgery, injury and long distance air travel.  Obesity and cancer can increase the risk of a PE.  Women on estrogen-containing hormones are at higher than average risk of getting a PE.  Genetic mutations involving factor V Leiden, prothrombin G2021A, procoagulant factor or other factors causing thrombophilia can contribute to getting a PE. 

The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factor is present.  People with protein S deficiency, antithrombin deficiency, plasminogen or fibrinolysis disorder or hyperhomocysteinemia will have a higher risk of getting a PE and needing to be on blood thinners for the rest of their lives. 

When a doctor is really suspicious for a PE and notes obvious clinical signs, he or she will skip the d-dimer test and go on to the CT-based dye study.    This is an excellent prediction tool and will tell if you have a PE fairly quickly and easily.  There are a number of predictive tools like the Geneva rule and the Well’s score that tells the doctor whether or not to rush to CT testing.  These tests are based on clinical factors noted and if the predictive factor is high, the doctor will go to CT scan and think about doing surgery or using TPA as soon as possible. 




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