Failure to Diagnose & Delay in Treatment of Deep Vein Thrombosis (DVT, Thrombus, Blood Clot)

Evaluate breaches in the standard of care when evaluating a Failure to Diagnose & Delay in Treatment of Deep Vein Thrombosis (DVT, Thrombus, Blood Clot)

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the patient present with symptoms of deep vein thrombosis?
    Yes
    No
    Symptoms not elicited
    Why is this important?
    Physical symptoms associated with deep vein thrombosis depend on the extent of vascular obstruction as well as the degree of inflammation and include pain, erythema, warmth and swelling of the involved extremity.
    (2011) 27 ECRICC 4 841-867

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Given the high risk of deep vein thrombosis that is not treated, and the potential risk of anti-coagulating a patient who does not have deep vein thrombosis, an accurate diagnosis is essential. Some patients may not present with classic symptoms, and such patients must be evaluated for all of the risk factors.
    (2011) 27 ECRICC 4 841-867

  • Was a thorough physical examination performed? Why is this important?
    Answer this question
    A carefully focused physical examination serves as the core of the diagnostic process. The deep understanding of the patient that can be obtained only through the immediacy of the history and physical examination also plays a pivotal role in treatment decisions that must be addressed at various points throughout the patient's lifetime.
    Click here for additional information at ClinicalKey.com

  • Was the patient discharged without performing diagnostic studies? Why is this important?
    Answer this question
    For patients with suspected deep vein thrombosis, objective testing is crucial because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious, including fatal pulmonary embolism.
    Click here for additional information at ClinicalKey.com

  • Which of the following investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Objective confirmation of the diagnosis through diagnostic imaging is necessary because of the sometimes nonspecific nature and ambiguity of the presenting signs and symptoms.
    (2011) 27 ECRICC 4 841

  • What was the result of the D-dimer test? Why is this important?
    Answer this question
    A positive D-dimer test may also be the result of other conditions. Thus, a positive D-dimer test means further diagnostic testing needs to be performed to determine if a DVT is present.
    (2011) 6 EULTRC 4 421

  • What was the result of the MRI/venogram? Why is this important?
    Answer this question
    Magnetic resonance venography is as accurate as contrast venography for the diagnosis of DVT.
    (2011) 6 EULTRC 4 421-433

  • What was the result of the venous ultrasound? Why is this important?
    Answer this question
    If venous ultrasound is the initial test and is positive, then the patient must be started on treatment for DVT. If venous ultrasound is taken up as the initial test and is negative, then it must be followed-up with D-Dimer test or a repeat ultrasound in one week.
    (2004) 42 ERDCNA 2 279-296

  • What was the result of the repeat venous ultrasound? Why is this important?
    Answer this question
    A positive D-dimer test may also result from other conditions. Thus, a positive D-dimer test means further diagnostic testing with venous ultrasound must be performed to determine if a DVT is present, while a negative result can exclude a DVT diagnosis.
    (2011) 6 EULTRC 4 421-433

  • Were investigations ordered by the clinician? Why is this important?
    Answer this question
    Objective confirmation of the diagnosis with imaging is important because of the nonspecific nature of the signs and symptoms.
    (2011) 27 ECRICC 4 841-867

  • Which of the following treatments were initiated? Why is this important?
    Answer this question
    Treatments for deep vein thrombosis: • Anticoagulant therapy with heparin and warfarin • Thrombolytic therapy • Inferior vena cava filters
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  • Was the aPTT (activated partial thromboplastin time) evaluated? Why is this important?
    Answer this question
    The aPTT must be checked within 6 hours of initiating the anticoagulant therapy and must be repeated every 6 hours for the first 24 hours of therapy.
    Click here for additional information at ClinicalKey.com

  • Was anticoagulation dosing adjusted as per the aPTT value? Why is this important?
    Answer this question
    The target aPTT is based on the therapeutic range defined by the laboratory of the healthcare facility. Using this therapeutic range, dosing adjustments of anti-coagulation therapy is made.
    Click here for additional information at ClinicalKey.com

  • Was PT/INR (Prothrombin Time/International Normalized Ratio) monitoring performed? Why is this important?
    Answer this question
    The INR is a comparative rating of prothrombin time (PT) ratios. The INR represents the observed PT ratio adjusted by the International Reference Thromboplastin. It provides a universal result indicative of what the patient’s PT result would have been if measured using the primary World Health Organization International Reference reagent.
    Click here for additional information at ClinicalKey.com

  • Was the INR value within the therapeutic range (between 2 and 3)? Why is this important?
    Answer this question
    For proper interpretation of INR values, the patient must be on a stable and consistent anticoagulant therapy. Click here for further information at Clinicalkey.com

  • Was heparin continued until therapeutic range of INR was achieved (Range between 2 and 3)? Why is this important?
    Answer this question
    Patients with DVT are to be treated with heparin until a therapeutic range (international normalized ratio [INR] between 2.0 and 3.0) is achieved.
    Click here for additional information at ClinicalKey.com

  • Which of the following prophylactic measures were recommended? Why is this important?
    Answer this question
    The most effective way to reduce mortality from deep vein thrombosis, pulmonary embolism, and from the post-thrombotic syndrome is to use primary prophylaxis in patients at risk for developing these conditions. Prophylaxis is achieved by reducing blood coagulability or by preventing venous stasis.
    Click here for additional; information at MD Consult.com

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Patients in whom deep vein thrombosis has been diagnosed and treated must have frequent follow-up assessments.
    (2011) 27 ECRICC 4 841