[Forensic medical implications of anticoagulant treatments]

Several types of accidents related to anticoagulant treatment can lead to legal procedures, including: thromboembolic post-operative complications associated with lack of anticoagulant prophylaxis and leading to sequelae or death; severe hemorrhagic or thromboembolic accidents attributed to poor management of anticoagulant therapy; complications with sequelae or death resulting from heparin-induced thrombopenia, either with standard or low-molecular weight heparin and associated with poor surveillance of platelet counts. The exceptional nature of accidents leading to legal procedures (24 legal cases in Pr Natali's experience) and the small number of other cases reported should not lead to underestimating the importance of precise rules for anticoagulation treatments. In 7 cases, there was no anticoagulant prophylaxis after surgery. Recent consensus conferences have proposed a definition of small, moderate or high risk of thrombosis as a function of patient status and surgical procedure. Expert working groups have defined the operated patients for which pharmacological anti-coagulation is necessary. In 19 other cases, management of the treatment protocol was insufficient leading to severe hemorrhage with sequelae, severe thromboembolism, or late diagnosis of heparin-induced thrombocytopenia because of insufficient surveillance of platelet counts. Recent advances in laboratory tests for the diagnosis of heparin-induced thrombocytopenia should be emphasized. To these case reports can be added other observations in a small number of complaints resulting from unadvisable treatment combinations, poor surveillance of a thromboembolic event or dangerous invasive exploration.