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Pulmonary Embolism and Deep Venous Thrombosis - Diagnosis and Treatment

Most malpractice claims involving deep venous thrombosis (DVT) and pulmonary embolism (PE) result from the failure to recognize patients at high risk for venous thromboembolism (VTE), according a recent survey run by The Doctors Company.  These medical malpractice cases usally involve the failure todiagnose the condition implement appropriate prophylaxis, failure to diagnose DVT in patients who subsequently have a PE, and failure to rule out PE in patients with nondiagnostic pulmonary symptoms.  The doctor owned malpractice insurance company's Medical Director stated, "When VTE is seriously considered in the differential diagnosis, it should be confirmed or excluded by appropriate testing."

David B. Troxel, M.D. advised other physicians of the proper diagnosis of DVT and treatment of VTE :

Diagnosis of Acute PE

The mortality rate is 30 percent when pulmonary embolism goes untreated.  These deaths are largely the result of a recurrent embolism.  The symptoms and signs of PE are relatively nonspecific.  These symptons include but are not limited to dyspnea, pleuritic pain, cough, hemoptysis, tachypnea, and tachycardia. Less than one-third of patients have symptoms or signs of DVT. 

Treatment of DVT

Recurrent PE within the first few hours is the cause of most PE deaths.  If there is a clinical suspicion or a actual diagnosis of PE, anticoagulant therapy should be promptly initiated.  This treatment should be with subcutaneous low molecular weight (LMW) heparin or intravenous unfractionated heparin.   The goal of this treatment should be to achieve a therapeutic level within the first 24 hours.  After this initial treatment, heparin should be continued for at least five days.  The heparin can be discontinued on day five or six if the internationalized normalized ratio (INR) has been therapeutic for two consecutive days.

Hospital medical staff protocols for the treatment of VTE should be followed in addition to the above procedures.  

Please read the actual article for a more accurate description of the protocol.

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