Testing in cases of unexplained pulmonary thromboembolism and atherosclerosis at autopsy?

Abstract

It is well known in medico-legal autopsies that patients die due to pulmonary thromboembolism after immobilization, especially after surgical treatment or other trauma. In these cases the prosecutor regularly wants to know whether this is an inevitable event or whether hospital personnel should have given the patient prophylactic short-term blood-thinners. Even if anticoagulants are given to a patient, the prosecutor and/or the relatives may ask how it is possible that the patient died due to pulmonary thromboembolism. Quickly the suspicion may arise that the wrong medication might have been given, or that the dosage was wrong, or that the medical file had been manipulated after the patient had died. In these cases testing for antiphospholipid antibodies in conjunction with the autopsy would quickly help to clarify the situation and to give answers to the relatives. Also, in cases of unusual advanced arteriosclerosis, which are quite common, the testing would be very useful for advising the relatives of the deceased about their own health risks. One of the reasons for performing an autopsy is not only to present a cause of death and to answer questions concerning the manner of death, but also to give clues about genetically determined disease. Only then do direct relatives have the opportunity to consult a medical genetic specialist to receive information about potential issues for their own health. The data presented in the paper by Bierton and Langlois [1], as well as in the literature cited, strongly indicates that it would be beneficial to establish and validate testing in laboratories associated with institutes of legal medicine. If we have a technique that allows us to answer questions and to clarify situations we should definitely use it.