Doctors Continue To Struggle With Blood Clot Treatment

Over two decades after scientists discovered a “breakthrough procedure” in stroke treatments, many patients still have no access to advanced tPA therapy, largely because of potential medical malpractice issues.

If ischemic (blood clot) stroke patients receive tissue Plasminogen Activator injections within three to four-and-a-half hours after the onset of symptoms, the tPA can effectively dissolve the blood clot, in many cases. The restored blood flow is often the difference between complete recovery and permanent disability. But like many advanced healthcare drugs, devices, and therapies, tPA is risky. tPA causes severe bleeding in about a fourth of the patients who receive it. If the patient is already in poor health or at risk, such bleeding could be devastating. Furthermore, a significant number of tPA patients experience brain hemorrhages or other such injuries. These wounds are always serious and potentially fatal.

As a result, many doctors shy away from tPA. Yale University’s Dr. Charles Wira says that many of the patients he sees came from other hospitals. The doctors there did not even inform the families about tPA. But Dr. Wira never brings up the issue. “We try not to raise issues that may lead to litigation,” he commented.


Blood Clots and Blood Thinners

tPA is not the only high-risk, high-reward therapy in this area. Doctors often use controversial Inferior Vena Cava filters in post surgical patients. These spider-like filters allow blood to flow normally through this critical artery in the leg. Restricted flow often leads to blood clots and Deep Vein Thrombosis (DVT). If the clot travels to a place near the heart or lungs, which is quite likely, DVT is potentially fatal.

IVC filters are not terribly sturdy and designed for only temporary use of perhaps a few weeks. If they remain in the IVC even a few days too long, serious side effects can occur. Some of them include:

  • Device migration or fracture,
  • Tissue perforation,
  • Cardiac Tamponade (fluid around the heart), and
  • Ventricular Tachycardia (dangerously fast heartbeat).

Beginning in 2010, the Food and Drug Administration warned of the dangers associated with IVC filters. Yet despite the escalating series of such pronouncements, the most recent of which was in 2014, these gadgets are still widely used. That means they are still widely misused.

The anticoagulant (blood thinner) Pradaxa is a preventative stroke medicine. It’s popular with doctors and patients, mostly because it requires less monitoring than Warfarin and some other anticoagulants.

Most patients who take any such drugs are more prone to things like mild bleeding, bruising, and bloody stools. Pradaxa is no exception. But according to the FDA, there is a very high risk of “serious bleeding events.” Perhaps even more disturbingly, Pradaxa has no fast-acting antidote, like Warfarin has. So, if such serious bleeding starts, it may be almost impossible to stop.


How Doctors React

The risks of these drugs, devices, and therapies often create a climate known as defensive medicine. Normally, this term is associated with unnecessary diagnostic tests. Doctors often order these procedures not because they are in the patient’s best interest, but because they are an effective defense in a malpractice claim. Essentially, the doctor can argue that s/he was not negligent because s/he examined every possibility.

The opposite is sometimes true as well. As Dr. Wira indicated above, some doctors shy away from potentially life-saving treatments because they are afraid of the liability aspects. That’s especially true if the doctor knows there were other gaps in patient care, if the doctor has been sued before, or the doctor knows someone who has been sued. Most physicians fall into at least one of these categories, so defensive medicine is very common.

To ease this problem, many states have passed tort reform laws that make it more difficult for victims to sue doctors, reduce the amount of compensation available, or both. However, there is very little evidence that these methods work and some indication that they may be counterproductive. Meanwhile, larger problems, such as the rise of Physician-Owned Distributorships (PODs, like surgery centers) go mostly unregulated.

Medical malpractice victims are entitled to significant compensation, but they must often overcome significant obstacles to obtain it. For a free consultation with an experienced personal injury attorney in New York, contact Napoli Shkolnik PLLC. We have nine office locations in eight states.