Dirty tatto + Early antibiotics => No severe cellulitis => No deep vein thrombosis => No pulmonary embolus => No death
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I don’t have the knowledge you do. I simply remember one of my doctor buddies getting sued for malpractice because he failed to prescribe an anti-coagulant to a patient who died of a bloodclot. He won.
It all depends on what point in the flow chart you come in at.
Initially, if the skin is hot and red, the leg is NOT swollen, there is no deep calf pain and the tatto is recent, then deep vein thrombosis is not yet a reasonable consideration. Anti-coagulation carries serious risks and a deep vein ultrasound is expensive so you don't initially go down that route with everybody with an EARLY skin problem.
Note, however, that I said "EARLY antibiotics" and put it right at the very beginning.
After the cellulitis is so severe that the clot has already formed, then you need BOTH antibiotics and anti-coagulation.
What are alarm bell for DVT?
Deep calf pain, not just skin pain, and swelling of the calf so that one calf is "fatter" than the other.
When you see a patient, you need to ask "What else could be going on?". After you answer that, you then ask, "What else could be going on?". Again and again.
The GP's thinking apparently went like this:
"The patient has pain and swelling after a tatto. What's going on?"
"I know! An allergic reaction to the ink. Here are pain meds and an anti-histamine."
The ghost of his medical school professor then appears and says, "Ummm .... Okaaay ..... Allergic reaction to the ink. Not at the top of MY list but .... Okay ..... Certainly plausible. ..... What else could be going on?"
"Nothing else that I can think of!"
"Infection, maybe?", prods the ghost.
"Nah! It's a reaction to the ink. I have covered all the bases!"
"Oy Vey! Okay, I won't take points off for missing the infection if you get the next question right. His calf is swollen. What ELSE could be going on?"
"Nothing else. It's a reaction to the ink. I have covered all the bases!"
"Fine ..... Let me page the Grim Reaper"
If you’re going to page him, page him already.