Drug may have contributed to DVT death

A BREAST cancer drug may have contributed to the death of a 49-year-old woman from deep vein thrombosis just five days after she was a passenger on a long-haul flight from America, an inquest heard.

A BREAST cancer drug may have contributed to the death of a 49-year-old woman from deep vein thrombosis just five days after she was a passenger on a long-haul flight from America, an inquest heard.

Sudbury woman Thelma Stacey died at her Grammar School Place home following a four-day shopping trip to New York last November.

A post mortem examination cited pulmonary embolism due to pelvic DVT as the cause of the company secretary's death, but yesterday's inquest in Bury St Edmunds heard a number of other factors may also have contributed.

These included existing varicose veins, pneumonia and the drug Tamoxifen, which is designed to suppress cancerous cells and had been prescribed to Miss Stacey following a mastectomy in 2001.

Giving evidence, pathologist Dr Laminos Munthali said the drug could increase the risk of blood clotting, but was unlikely to have been the sole cause of Miss Stacey's DVT.

This view was supported by Dr Tony Goodwin, an aviation medical expert working with Virgin Atlantic – the airline with which Miss Stacey travelled to America.

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"The jury is still out on the relation of aviation to DVT," he said. "Certainly, groups of people have risk factors making them more prone to DVT than others, and these include a history of clotting or some quality in the blood which makes it more sticky.

"Airlines have now been urged to make people aware of the possible difficulties, and will give sensible advice to anybody admitting a medical problem and risk assess the passenger to see if they would be at any danger from flying."

He added that studies were currently underway to establish if risks of DVT were increased by air travel.

During the hearing, 53-year-old John Hortop, Miss Stacey's partner of ten years, described the symptoms she suffered after returning home on November 19.

He told the inquest Miss Stacey had appeared jetlagged and tired, and suffered an inflamed vein in her thigh known as phlebitis within twenty-four hours of landing at Heathrow.

This tender lump was examined by GP Dr Susan Sills, who discussed the symptoms of DVT with her patient and warned her of other telltale symptoms to watch for.

Three days after this consultation, Miss Stacey suffered sickness and flu-like symptoms, prompting Mr Hortop to contact Dr Andrew Crouch, of the Hardwick House Surgery in Sudbury.

"The doctor told me he could diagnose the problem over the phone, and prescribed some tablets for the sickness," said Mr Hortop. "He did not ask to speak to Thelma, but I told him she was not a complainer, and was not the kind of person who would call the doctor for no reason.

"The next morning, she woke me up at around 5am. Her breathing was fast and chesty, and I called the doctor again. When I came back from making the call, she was just exhaling. It was all too late."

Giving evidence, Dr Crouch said he made the decision not to visit Miss Stacey after diagnosing her symptoms, via the telephone, as a gastric condition.

"All I can say is I was happy I had dealt with the matter in an appropriate manner, and diagnosed what at the time sounded just like gastric flu," he said. "I do not know if visiting the patient would have made any material difference to the outcome, as DVT is a very difficult condition to diagnose whether you examine someone or not.

"Of course I wish there had been a different outcome, but I thought I had done my best to secure a reasonable treatment for Thelma."

Recording a narrative verdict, Dr Peter Dean, coroner for Greater Suffolk, attributed Miss Stacey's death to pulmonary embolism secondary to DVT following a long distance flight.

"The thrombosis developed against a background of some recognised risk factors," he said. "What comes across from all of the medical evidence is the fact that many factors all acting together lead to the DVT.

"What we do not know is if the outcome could have been different had Dr Crouch visited, as much of the time DVT can occur without any signs or symptoms."

Closing the hearing, Dr Dean said he plans to highlight the increased risks those prescribed Tamoxifen face from air travel in a letter to the appropriate authorities.

Following the verdict, Peter Richards, representing Miss Stacey's family, said: "This has been a difficult day for Thelma's partner and her family.

"They are grateful all the evidence has been heard, and accept the learned coroner's verdict and the reasons for that verdict."