March is national Deep-Vein Thrombosis (DVT) Awareness Month, a public health initiative that seeks to aid understanding of this commonly occurring and potentially life-threatening medical condition amongst the general population.
DVT is commonly referred to as a blood clot (thrombus) that forms in one or more veins located deep inside the body. DVT typically develops in the leg, although it can occur elsewhere, and it essentially blocks normal blood circulation. This condition can be very serious because blood clots in the deep veins can break off, travel through the bloodstream and become lodged in one of the blood vessels in the lungs. This is known as a pulmonary embolism (PE) and requires emergency treatment as it can have fatal consequences. Together, DVT and PE are known as venous thromboembolism (VTE).
DVT can occur without any noticeable signs or symptoms. However, when they do present, the most common characteristics of DVT in the leg include:
If an individual experiences signs or symptoms of DVT, they should contact their doctor so this can be investigated as soon as possible.
Ultimately, anyone can develop DVT. However, there are many factors that can increase an individual’s risk of a blood clot forming. The more risk factors that an individual possesses, the greater their risk of DVT. Risk factors include:
Sometimes, DVT can occur with no apparent underlying risk factor - this is known as an unprovoked DVT.
Where DVT is suspected, a medical professional should undertake sufficient investigations so that a definitive diagnosis can be ascertained. A doctor may initially suggest a specialised blood test called a D-dimer test. This test detects pieces of blood clot that have broken down and are loose in the bloodstream. The larger the number of fragments found, the more likely it is that an individual has a blood clot in the vein. However, a D-dimer test is not always reliable, and the results can be affected by various factors such as injury, surgery or pregnancy. Therefore, additional tests, such as an ultrasound scan, need to be carried out to confirm the presence of DVT. An ultrasound can be used to detect clots in the veins as it can show whether blood is flowing normally or if there is a blockage. If a D-dimer test and ultrasound scan cannot confirm a diagnosis of DVT, a venogram may be used. During a venogram, a liquid called a contrast dye is injected into a vein in the foot. The dye travels up the leg and can be detected by x-ray, which will highlight a gap in the blood vessel if a clot is obstructing blood flow.
DVT can develop for no obvious reason but there are preventative measures that can be taken to reduce the risk of a clot forming. Individuals who are considered high-risk, such as those who have recently undergone major surgery or those with a history of VTE, may be prescribed small doses of anticoagulants to reduce their risk. This is known as thromboprophylaxis.
Those undertaking long-distance journeys by plane, train or car should perform regular leg exercises, take frequent walking breaks and stay hydrated, as these actions have been shown to reduce the chances of DVT occurring during long-distance travel. In addition, using compression stockings has also been proven to lower the risk of DVT quite considerably.
Further lifestyle changes that can help reduce the likelihood of a clot occurring include stopping smoking, eating a balanced diet, exercising regularly, maintaining a healthy weight, reducing alcohol consumption and drinking plenty of fluids to avoid dehydration.
All patients should be risk assessed for VTE on admission to hospital and a VTE risk assessment chart should be completed. For all surgical patients, and all medical patients with significantly reduced mobility, a comprehensive risk assessment should be carried out. If a thrombosis risk is identified, this should prompt thromboprophylaxis. Compression stockings may also be given to high-risk patients whilst they are in hospital. In addition, appropriate follow-up care should be undertaken after a patient has been discharged as DVT can occur weeks after a hospital stay or surgery.
Treatment for DVT usually involves taking anticoagulant medicines. These reduce the blood’s ability to clot and stop existing clots increasing in size. In the first instance, an individual will usually be prescribed heparin, a type of anticoagulant, as it works immediately to prevent further clotting. Following this, an individual may be prescribed warfarin to prevent another blood clot forming. There is a range of anticoagulants, known as directly acting oral anticoagulants (DOACs), that may also be used to treat DVT and these include rivaroxaban and apixaban. Compression stockings can be prescribed to improve symptoms and help prevent associated complications.
A less common treatment method is the placement of an inferior vena cava filter, which can be inserted into the body to trap a blood clot and stop it from travelling to the heart and lungs. In certain circumstances, a clot can be surgically removed. However, both methods are invasive procedures and are generally only used if anticoagulant medicines are not suitable.
The clinical negligence team at Penningtons Manches Cooper has a vast amount of experience advising on claims relating to DVT and PE. The team has acted on behalf of clients who have suffered harm due to a failure to detect DVT or a PE promptly, or due to a failure to provide adequate and timely treatment. The practice has also previously acted on behalf of families that have tragically lost loved ones due to delayed diagnosis or treatment of DVT and PE, which in these cases has unfortunately resulted in cardiac arrest, hypoxic brain injury and ultimately death.
As is the case with many conditions, with early medical intervention DVTs and PEs are treatable and preventable. Therefore, it is imperative that DVTs and PEs are diagnosed early and treated promptly to reduce the risk of more serious, potentially fatal, complications. It is important that medical professionals complete a full risk assessment for high-risk patients, and that adequate measures are put in place to prevent DVTs and PEs from developing. If DVT or a PE is suspected, it should be acted on without delay, appropriate referrals should take place and sufficient investigations should be conducted. A thorough assessment of treatment options, with a careful evaluation of the risks and benefits of each of the various treatments available, should also be undertaken.
Varisha Gorasia, an associate in the clinical negligence team at Penningtons Manches Cooper, comments: “Deep-vein thrombosis is a common condition that affects around one person in every 1000 in the UK each year and can potentially prove fatal. This is why the Deep-Vein Thrombosis Awareness Month initiative is so important as it gives us an opportunity to use our expertise and our platform to increase awareness about this condition, in the hope that cases may be prevented, diagnosed and treated more effectively.”