Pulmonary Embolism and Oral Contraceptives

Due to a recent case, CPSM reminds registrants of the need for vigilance regarding the risk of deep vein thrombosis (DVT) and pulmonary embolism with oral contraceptive use.

A young female patient presented as an outpatient with lower leg pain and some subtle changes in vital signs. The patient was assessed and treated for a musculoskeletal injury but subsequently died due to a pulmonary embolism. Examination at the outpatient visit did reflect the consideration of DVT. 

A review noted that the documentation did not address the patient’s general presentation and subtle abnormalities of vital signs. Medications were noted; however, the patient may not have volunteered her oral contraceptive use and it was not recorded. 

This outcome serves as a reminder for all registrants:

·         In the acute setting, assess the patient’s general presentation and vital signs, even in the context of apparent minor musculoskeletal system trauma.

·         Consider broader non-musculoskeletal system causes in your differential diagnosis.

·         Consider asking specifically about oral contraceptive use, past medical history, and family history where appropriate.