23 February 2012
Paul Sankey discusses Deep Vein Thrombosis (DVT): The Hidden Risks
One of my recent cases concerned a young man who died after his DVT (Deep Vein Thrombosis) was undetected, despite correct investigations by his GP and going to Accident and Emergency. The case highlights quite what a serious and common issue this is. Few people realise quite the significance of DVT. It kills more people in hospital as a result than from Breast Cancers, AIDs, MRSA and Road Traffic Accidents put together. It is estimated that 25,000 to 32,000 people die from the condition in hospital every year – 10% of deaths in hospital. However this figure may be an under-estimate: few post mortem examinations are done and many people will die of the condition without anyone realising.DVT is a blood clot in one of the deep veins, normally in the leg. In most cases they start in the calf. When they progress above the knee to the thigh, part of the clot can break off, causing clots in the Heart and Lungs (Pulmonary Embolism) which can be fatal. Nearly a third of people with Pulmonary Embolism will die if not treated.People with DVT commonly suffer calf pain. However in many cases there are few or no clinical signs. This may mislead doctors. Errors occur where they fail to recognise the risk and investigate. In my recent case the Emergency Department recognised the risk but still failed to investigate. Mistakes can also be made if doctors misinterpret investigation results – which is the mistake the GP made in my case.Investigations are relatively simple. A D-dimer blood test can be done and produce results very quickly. A negative result makes a diagnosis of DVT unlikely. If there is a significant risk an ultrasound scan can confirm or rule out the diagnosis. Treatment with anti-coagulating drugs is very effective. It is crucial therefore that doctors are on the look-out for this common and serious condition. Mistakes are probably few and far between but they can be tragic.
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