Anticoagulant Meds: Missing Post-Op Instructions
Case Reference:
The parties reached a confidential settlement. The Estate of Joseph Richard Karlen by Ruth Eloise Karlen v. Christopher Richard Powers, M.D. and Medical Center Associates of Houston, LLP. Harris County (TX) District Court No. 201551289. Terry Bryant, Houston, TX for plaintiff. Marikay Evans of Luccia & Evans, Houston, TX for defendants.
Keywords:
anticoagulation, anticoagulant, cardiologist, presurgical, Warfarin, INR, internal bleeding, postsurgical, postoperative, negligence, negligent, treatment plan, therapy plan.
Case Overview
The patient received successful gallbladder removal surgery by a physician other than the patient's cardiologist. The cardiologist consulted on the discharge instructions to include a specific anticoagulation therapy plan involving the patient's presurgical medication Warfarin.
The patient's cardiologist explicitly instructed to discontinue the anticoagulant for two days and have his INR retested three days post-surgery to determine the correct dosage or follow-up course of action.
The defendant directed the patient to continue with his presurgical Warfarin dose, unchanged, upon returning home. Several months later, the patient suffered the effects of the accumulation of excessive anticoagulation, resulting in internal bleeding, perihepatic hematomas, and death.
The patient's estate claimed that the defendant was negligent, that he violated standards of care, failed to follow, and give the patient the cardiologist's instructions defining the postsurgical anticoagulation therapy plan.
Although the defendant denied the allegations of negligence, the parties arrived at a confidential settlement.
DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.
Anticoagulant Medications: Importance of pre-operative & post-operative instructions.
Increased levels of anticoagulation medications can pose a risk for bleeding due to the inability of the essential blood-clotting mechanisms to control bleeding.
Postsurgical patients are especially susceptible to internal bleeding. The body relies on the clotting mechanisms to prevent excessive pooling of blood at the location of the incision and surgical sites.
Whereas, pooling or shunting of blood away from the surgical site inhibits the recovery process without proper blood supply and nutrients required to promote healing.
Temporarily suspending postsurgical anticoagulation medication administration will allow the blood to clot at the areas of bleeding, creating a hardened plug that will withstand and continue healing when anticoagulants are resumed.
The INR is a periodic blood concentration test that determines the therapeutic effect of Warfarin - how effective or when to discontinue or adjust the medication.
Medical Records: Failure to review specific instructions.
The patient's medical record will usually have a standardized method to identify patients who are taking anticoagulants quickly visually.
This information is available to the person preparing the patient's discharge by merely viewing the medical record and reviewing any discharge instructions provided for the patient.
The failure to review specific patient instructions or thoroughly reading the patient's medical information is particularly negligent.
All medical professionals with patient responsibilities are required to follow-up on new entries in the medical record and abide by any changes and treatment plans.
The cardiologist adjusted the specific anticoagulant discharge instructions; the defendant should have been aware of this entry in the patient's medical record.
Instead, the defendant verbally discussed or possibly included in the patient's discharge documents to continue with the presurgical dosage without verifying for accuracy.
The defendant should have had enough knowledge and awareness of potential outcomes if continuing Warfarin immediately postoperative.
Anticoagulation Medications: When to reinstate?
The decision to reinstate anticoagulation medications after surgery depends on the complexity of the operation and the projected risk of bleeding.
This variation of reinstatement requires careful evaluation of discharge instructions or collaboration with interdisciplinary members to ensure accuracy and patient safety.
Additionally, the patient should have received instructions on the potential side effects of surgery and the adverse effects of all medications to begin or resume when returned home.
Patient education should include actions to take in the presence of symptoms and when to seek medical treatment.
The defendant failed to review necessary patient information, interdisciplinary discharge instructions, and provide sufficient patient education to enable recovery and reduce complications, which resulted in a preventable fatality.
DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.
Do you have questions about a medical case or need help understanding treatment plans and options?
Cardio Med Legal Dr. Jasdeep Dalawari
(804) 991-4109 - info@cardiomedlegal.com
