Is failure to provide venous thromboprophylaxis negligent?

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Abstract
Objectives: To report the outcome of 100 consecutive medicolegal claims referred to one of the authors (1990–2003) following the development of venous thromboembolism (VTE) in surgical patients. Methods: A retrospective analysis of the experience of a vascular surgeon acting as an expert witness in the United Kingdom. Results: Prophylaxis had been provided to 43 claimants with risk factors, who, unfortunately, still developed a VTE and alleged negligence. Twenty-nine claims involved patients who had not received prophylaxis because they were at low risk. In 25/28 claims where no prophylaxis was provided, despite identifiable VTE risk factors, the claim was successful. Claimants who developed a VTE that had been managed incorrectly were successful whether they had received prophylaxis or not. Settlement amounts, where disclosed, are reported. Conclusions: Failure to perform a risk assessment and to provide appropriate venous thromboprophylaxis in surgical patients is considered negligent. Clinicians looking after all hospitalized patients who are not assessing their patients' risk for VTE and/or not providing appropriate prophylaxis are at risk of being accused of negligence.

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