Blood Thinner Do's and Don'ts
Woman Has Leg Amputated At 22 After Doctors Took 16 Hours To Treat Her Blood Clot
Molly Harbron is now reliant on a prosthetic leg and a wheelchair after she lost her leg in April 2020 after medics failed to act quickly enough, causing a 16-hour delay in treatment for a blood clot
Molly in hospital, post amputation (Image: Courtesy Irwin Mitchell / SWNS)
A 25-year-old carer had her leg amputated after doctors took too long to treat a "tingling sensation" during lockdown.
Molly Harbron is now reliant on a prosthetic leg and a wheelchair after she lost her leg in April 2020 after medics failed to act quickly enough, causing a 16-hour delay in treatment for a blood clot. She said she was left feeling that "life wasn't worth living" after she awoke from surgery to a missing limb, but has since defied the odds and walked down the aisle three years later.
Molly, who is now seeking compensation for her rehabilitation, was 22 when she went to Dewsbury and District Hospital's A&E department at around 11:30am on April 25, 2020. She was diagnosed with diabetic ketoacidosis, a life-threatening complication, and admitted to the ward just after 7:30pm.
But around 30 minutes later, following a review, it was suspected she had a deep vein thrombosis. Following a further review, medics were concerned about reduced blood flow to her lower left leg and called another hospital for an opinion. A radiology report at 11:30pm suggested Molly had blood clots and a blocked artery behind her left knee.
She was eventually transferred to another hospital and was in theatre for surgery just after 1:30pm on April 26, more than 16 hours later. Surgeons could not restore blood flow to her lower left leg, and after first undergoing a below-the-knee amputation, they removed more of her limb above her knee days later. Molly spent a further 18 days in hospital and had to give up her job as a carer.
Speaking of her ordeal for the first time, Molly, from Batley, West Yorks., said: "Before all this, I was extremely active. I worked in a quite physically demanding job and enjoyed going out with my friends, shopping and all of the things people my age do. However, that's all completely gone. It's sometimes difficult to find the words to describe how my life has changed.
Molly Harbron, 25, with husband Daniel on their wedding day (Image:
Courtesy Irwin Mitchell / SWNS)"It's not just the physical injuries which have been hard to come to terms with but also the psychological impact. I went from being quite independent to being reliant on others. I do have a prosthetic leg but it's not specifically designed for me. I suffer walking any kind of distance and I suffer with pain when using it so I tend to use a wheelchair. This never should have happened so I just hope that by speaking out I can prevent it happening to someone else."
Mid Yorkshire Teaching NHS Trust, which runs Dewsbury and District Hospital, later admitted a breach of duty and apologised to Molly. If it was not for the breach of duty, Molly would have undergone surgery by 9pm on the day she attended hospital. On the balance of probabilities, the surgery would have been successful and would have avoided the need for both the below and above-knee amputation, the Trust admitted.
Molly instructed expert medical negligence lawyers at Irwin Mitchell to investigate her care under the Mid Yorkshire Teaching NHS Trust. They are now working to agree on a settlement, which will fund the lifetime therapies, to support and rehabilitation Molly requires. Molly's lawyer Ashlee Coates, from law firm Irwin Mitchell, said: "The last few years and coming to terms with the avoidable and life-changing consequences of Molly's amputation have understandably been extremely difficult for her and her family.
Molly Harbron before her leg was amputated (Image:
Courtesy Irwin Mitchell / SWNS) Molly Harbron, 25, on her wedding day. (Image:
Courtesy Irwin Mitchell / SWNS)"What happened to her vividly highlights the repercussions of what can happen when patient care falls below expected standards. While nothing can make up for the physical and psychological trauma Molly has experienced, we're determined to ensure she can access the specialist care and therapies she needs to continue her recovery and live as independently as possible. In the meantime it's vital that lessons are learned to improve patient safety for others."
Richard Robinson, Chief Medical Officer at the Mid Yorkshire Teaching NHS Trust, admitted they needed to "get better". He said: "We aim to ensure all patients get the right diagnosis and the treatment they need to get better. In Mrs Harbron's case that did not happen and for that I am sincerely sorry."
Comparing Deep Vein Thrombosis And Superficial Thrombophlebitis
Deep vein thrombosis (DVT) is a blood clot that forms inside a vein deep in the body, whereas superficial thrombophlebitis (STP) is inflammation of the veins just below the skin's surface. STP can occur due to a blood clot in a superficial vein.
DVT is a medical emergency. Without immediate treatment, it may lead to severe complications or even sudden death.
In contrast, STP may resolve without the need for medical treatment. However, it may also increase the risk of developing DVT. If a person has symptoms of DVT or STP, it is best to seek medical help.
This article compares the symptoms and causes of DVT and STP, outlines their treatments and outlooks, and provides tips on how to help prevent blood clots.
The following sections outline the potential symptoms of DVT and STP.
DVT symptomsDVT can develop in any of the body's deep veins, but it typically develops in deep veins in the pelvis, thigh, or calf.
According to the American Academy of Orthopaedic Surgeons (AAOS), DVT often does not cause symptoms. However, when symptoms do occur, they affect the part of the body where DVT occurs.
DVT in the leg may cause the following symptoms in that leg:
For some people, a pulmonary embolism may be the first sign of DVT. This is a blood clot in the lung and may cause the following symptoms:
STP symptomsAccording to the United Kingdom's National Health Service (NHS), STP usually affects the superficial veins in the legs but can also affect the superficial veins of the arms or neck.
STP may cause the following symptoms in the affected part of the body:
Below are some causes of DVT and STP, as well as some of the risk factors associated with each of these conditions.
DVT risk factorsDVT forms when blood flow within one of the body's deep veins slows or stops. According to the Centers for Disease Control and Prevention (CDC), some factors that can increase the risk include:
According to the NHS, STP does not always have a clear cause. Inflammation may occur due to:
Other risk factors for STP include:
Below are the different treatment approaches for DVT and STP.
DVT treatmentAccording to the AAOS, DVT treatment aims to prevent the clot from getting larger, minimize the risk of complications, such as a pulmonary embolism, and reduce the risk of other clots.
Treatment options include:
Nonsurgical DVT treatments are the most common. However, doctors may recommend surgical treatment for DVT in cases where anticoagulants are ineffective or a person is unable to take anticoagulants.
STP treatmentAccording to the NHS, STP that causes only mild symptoms may not require treatment.
However, severe or persistent STP may require treatments such as:
The outlooks for those with DVT and STP differ, with DVT presenting the greatest risk to health.
DVT outlookAccording to the CDC, between 60,000 and 100,000 Americans die of DVT every year, with sudden death being the first symptom in approximately 25% of cases.
Of those who survive DVT, around 1 in 3 will experience long-term complications. The most severe is a pulmonary embolism. Another is a condition called post-thrombotic syndrome (PTS).
PTS develops in roughly 1 in 3 people who survive DVT. The condition occurs due to clot-induced damage to the valves within the vein. Symptoms develop in the affected body part and may include:
The CDC also estimates that 1 in 3 people who survive the initial DVT will experience DVT again within 10 years.
STP outlookAccording to the NHS, STP is not typically a medical emergency and usually resolves without treatment within 1–2 weeks.
However, a 2017 review notes that STP often occurs alongside asymptomatic DVT. Therefore, the reviewers recommend that all individuals presenting with STP symptoms receive an ultrasound scan to check for DVT.
According to the review, STP can also progress to DVT in some cases. The authors recommend that individuals at risk of developing DVT receive low dose anticoagulant medications as a preventive measure.
The American Heart Association (AHA) recommends strategies for helping prevent blood clots in high risk situations, such as during periods of inactivity due to surgery, hospitalization, or long-distance travel.
Methods to help prevent blood clots include:
It is best to contact a doctor as soon as possible if a person develops symptoms of STP. Although STP is rarely dangerous, research suggests that it can occur alongside DVT or progress to DVT.
Anyone who develops symptoms of DVT should seek emergency medical care immediately. DVT is a life threatening condition that can lead to sudden death. Emergency medical treatment with anticoagulation medication can save a person's life.
Potential DVT symptoms to look out for include:
Deep vein thrombosis (DVT) and superficial thrombophlebitis (STP) are conditions of the circulatory system. DVT is a blood clot that forms in a deep vein, whereas STP is inflammation of the superficial veins close to the skin's surface.
STP is typically not a medical emergency. However, research suggests that STP may increase a person's risk of developing DVT. Anyone who experiences symptoms of STP should speak with their doctor for a thorough medical evaluation.
DVT is a medical emergency. Anyone who experiences symptoms should phone the emergency services immediately. Prompt treatment with anticoagulant medications or surgery can help prevent complications, including death.
Bayer Takes Novel Deep Vein Thrombosis Drug Into Phase 2
Bayer has started proof-of-concept testing of a potential new therapy for patients with deep vein thrombosis (DVT) that works in a different way to current drugs.
The German group has started a phase 2 trial – called SIRIUS – that will look at the effect of its anti-alpha2 antiplasmin (anti-α2ap) antibody BAY3018250 in patients with DVT, which occurs when a blood clot forms in one or more of the deep veins in the limbs, usually the legs.
Along with being painful, a DVT can be very serious because the clots can travel to the lungs and cause a life-threatening pulmonary embolism.
BAY3018250 blocks the effect of α2ap, the main physiologic plasmin inhibitor in the body and an integral part of the blood clotting mechanism, helping to dissolve clots in situ. High levels of α2ap have been linked to poor outcomes in various cardiovascular diseases, including ischaemic stroke.
Bayer is hoping that the antibody could provide an alternative to thrombolytics like t-PA, which are only moderately effective at dissolving blood clots in DVT. Thrombolytics frequently cause mild or moderate bleeding complications, and sometimes major complications, and are not suitable for every patient.
"We are excited to advance our anti-α2ap antibody to the next stage of clinical development in patients with deep vein thrombosis," said Christian Rommel, Bayer's R&D chief.
"This study will also help to better understand if the anti-α2ap antibody is suitable as a thrombolytic to treat patients in indications of high medical relevance," he added. "By targeting alpha2 antiplasmin, we will have a more precise approach to modulate plasmin to break down thrombotic blood clots."
The placebo-controlled SIRIUS trial follows a first-in-human study that backed up the safety of BAY3018250 and will enrol around 250 patients with proximal DVT – in other words, clots that occur in the veins of the hip, thigh, or knee – and have received standard anticoagulant therapy.
Ultrasound scans will be used to evaluate the clot burden before and up to 90 days after treatment, and the patients will be randomised to either placebo or one of two doses of BAY3018250. The main outcome measure will be how effective the drug is in dissolving blood clots, as well as safety, including the risk of bleeding complications. Results are expected in the first half of 2025.
Stroke, meanwhile, is another tantalising potential indication for the drug, assuming it advances further through development. Along with being a risk factor for stroke, high α2ap levels have also been linked to a lower success rate with thrombolytics for acute ischaemic stroke – currently the only approved therapy to restore blood flow to the area of the brain where the blood clot forms.
Bayer has a strong track record in thrombosis, with the development of Johnson & Johnson-partnered Factor Xa inhibitor Xarelto (rivaroxaban), a direct oral anticoagulant (DOAC) that is Bayer's top-selling drug with sales of around €3 billion ($3.2 billion) in the first nine months of 2023.
Xarelto is facing the onset of generic competition, however, with patent protection due to expire in 2026.
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