pulmonary emboli and deep vein thrombosis

Since there was publicity about the problem of blood clots forming in the deep veins of the legs associated with airline flights, details of these conditions are more widely known.  There can be certain blood clotting tendencies which are inherited and there may be a history of these conditions within family members.

A venous thrombosis is where the blood in the larger veins, usually of the legs, clots and is knowns as deep vein thrombosis or 'DVT'.  The blood in these veins flows more slowly than the blood in arteries.  Consequently these clots are sometimes referred to as red thrombus because they contain many red blood cells.

The blood clot in the leg can cause pain and swelling which is uncomfortable.  The danger of the condition is that part of the blood clot will dislodge, travelling through the large veins through the right side of the heart and then become lodged in the pulmonary arteries which transport blood through the lungs.  This is known as a 'pulmonary embolism'.  A clot in the upper leg is much more likely to be dangerous than one in the lower leg.  The consequences of the blood clot travelling in the circulation depend upon its size. It may have the following effects:

• sudden death. If the clot is large enough it may block up the heart or the very large blood vessels entering the lungs. If this happens the circulation can collapse. Sometimes in hospital extremely urgent treatment measures to remove the clot can be undertaken but this is also dangerous and has a high mortality
• unexplained collapse, often associated with chest pain. A moderate sized blood clot will travel through the circulation and lodge in the lungs. It will be sufficiently large to cause the patient to collapse but they may be able to survive the episode. If the diagnosis is not appreciated then further blood clots may follow. Alternatively, the blood clot which has become lodged can start to spread known as propogation of the clot. The circulation then deteriorates and there is a serious threat to the patient’s life
• chest pain, with breathlessness and possibly pleuritic or pleurisy type pain. A patient can survive a small pulmonary embolus. This is however often a warning sign. Unless the blood is anti-coagulated then further clots may occur, possibly with fatal consequences

There are a variety of risk circumstances for sustaining a deep vein thrombosis. Some are associated with surgical treatment but others with physiological states. Risk factors include:

• pregnancy
• pelvic surgery
• some oral contraceptive pills
• immobility because of illness

Claims occur where there are failures:

• in the context of elective surgery properly to take preventative measures. This might include anti-deep vein thrombosis stockings, or administration of subcutaneous heparin, an anticoagulant of the blood; or
• to diagnose the occurrence of smaller pulmonary emboli before a fatal embolism occurs

We are frequently asked to investigate cases where the patient has died.  In those circumstances a claim can be brought by the family members on behalf of the estate of the patient and in their capacity as dependents.

We are able to provide expert advice concerning the circumstances and technical aspects to the medical litigation.  We are also able to give expert legal advice to executors and dependents bringing actions under the Law Reform (Miscellaneous Provisions) Act 1934 and Fatal Accidents Act 1976.

For further information please contact Alison McClure in the Clinical Negligence team on 023 8085 7345 or email alison.mcclure@bllaw.co.uk.