Far-reaching consequences: the importance of recognising blood clot risks

Posted: 19/03/2025

Blood clots can be extremely dangerous to a person’s health, but the risk of them developing can be minimised and they are reasonably straightforward to treat when they are diagnosed early enough. 

Clinically known as a thrombus, a blood clot can develop in a vein deep in the body and is then called a deep vein thrombosis (DVT). The clot forms because of sluggish blood flow due to damaged or unhealthy veins or after a long period of immobilisation, such as a long-haul flight. In a healthy vein, blood flows freely and mixes with natural substances in the blood that keep it from clotting. If the flow is slowed, the blood does not mix with these natural anticoagulants and clots more easily. Most DVTs happen in the lower leg, thigh, or pelvis, but they can also occur in other parts of the body such as the arms, brain, intestines, liver, or kidney. In general, DVT strikes slightly more men than women.

When a blood clot is missed, patients can develop deep vein thrombosis, pulmonary embolisms, or cerebral embolisms. A pulmonary embolism is a blood clot that has travelled up to and lodged in the pulmonary artery, which carries blood from the heart to the lungs. A cerebral embolism is a blood clot that has travelled to the brain, where it can block oxygen and blood flow and cause an embolic stroke. 

Patients undergoing orthopaedic surgery face an increased risk of developing a blood clot, usually presenting initially as a DVT, but with the potential to break free and travel through the bloodstream. The risk of blood clot development is highest for the first 10 days post-surgery, but remains elevated for approximately three months. The risk should be managed with good clinical care including preventative measures such as compression stockings, blood thinners and advice regarding mobility and leg exercises. 

Tragically, our clinical negligence specialists have seen the impact of clinical care in this area falling short, resulting in a blood clot having fatal consequences.

We have recently settled a claim for a woman who was widowed at a young age when her husband died from a pulmonary embolism after orthopaedic surgery. Our client’s late husband had a medical history, which included a DVT following a long-haul flight. He was then anticoagulated with warfarin and, for a while, had to use crutches to mobilise. 

At around the same time, possibly through having to use crutches, he developed a problem with his right Achilles tendon. Following an orthopaedic referral, he was advised to undergo surgery in the form of a bilateral gastrocnemius release. The surgery went ahead but according to a serious incident report by the NHS trust where the operation took place, his high risk of venous thromboembolism (VTE) was not recognised on a number of occasions, both before and during his day surgery.

One week following the procedure, he collapsed at home and died. He had suffered a cardiac arrest caused by a pulmonary embolism, believed to have originated as a DVT. He was aged only 54 when he passed away; his wife was 47 years old at the time.

We brought a claim and secured an admission of liability that the NHS trust had failed to recognise that the patient was at a high risk of developing a blood clot. On causation, the claimant outlined her case that on the balance of probabilities adequate prophylaxis would have prevented the further DVT her husband suffered and would have avoided the fatal pulmonary embolism. Ultimately, this led to a full admission of breach of duty and causation. 

Our clinical negligence team undertook a forensic analysis of income, expenditure, and loss of financial dependency, involving a painstaking line by line analysis of all bank statement entries and commissioning forensic accountancy evidence, to support a loss of dependency claim for our client based on her late husband’s income and pension. This approach, a departure from the traditional dependency calculations, was contested by the defendant trust but ultimately the claim was concluded successfully at a settlement meeting.

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