Coumadin Death: Jury Returns $2.4 Million Verdict

2022 Medical Malpractice Verdict Report
July 21, 2022 — Middlesex Superior Court
By Attorney Adam R. Satin

70-year-old woman bleeds to death following cardiologist’s failure to monitor anticoagulation levels

Case summary

The decedent had an extensive cardiac history dating back decades, including atrial fibrillation and two mechanical heart valves. She was maintained on the anticoagulant medication Coumadin due to her stroke risk. 

Patients taking Coumadin require periodic blood tests to monitor their INR level to inform their doctor about the level of anticoagulation. If the INR is too low, the risk of clotting remains. If the INR is too high, there is a risk of bleeding. When someone has had stable INR testing on a stable dose of Coumadin, the INR monitoring may be as infrequent as monthly. However, the plaintiff’s expert opined that when starting (or restarting) Coumadin and/or when introducing a new medication that can impact the effects of Coumadin, more frequent INR testing is required by the standard of care to establish (or re-establish) a stable baseline.

The defendant was the patient’s cardiologist for several years. In 2014, the defendant recommended elective replacement of the pacemaker battery. Coumadin was appropriately stopped for 5 days prior to the procedure to minimize the risk of bleeding. The Coumadin was resumed after the procedure. One day later, the patient went to the defendant’s office due to bleeding and a hematoma at the site. Due to the risk of an infection in the area, the defendant started the patient on an antibiotic, Bactrim, which the decedent took as directed for 5 days. Bactrim is a medicine that increases the effects of Coumadin. 

The next day, the defendant ordered an INR test, which resulted at 3.2 — more than double the previous INR around the time of the procedure. The defendant said the patient could have her next INR in one month. Less than a month later, however, the decedent was brought to the emergency room with clear signs of bleeding. She was grossly anemic and had an INR of 22.8. Efforts were made to replace her blood loss but she coded multiple times and was pronounced dead the next day.

Plaintiffs claimed that the defendant was required to order serial INR tests until a new baseline was established after the Coumadin was restarted and particularly after having been given Bactrim which is known to increase the effects of Coumadin.

The defendants argued that the INR of 3.2 was reassuring and that the potentiating effects of Bactrim would have been out of the system once the Bactrim was stopped.

Jury verdict in favor of plaintiffs

The jury awarded $2,409,318.00 with interest.

Lubin & Meyer's Adam R. Satin represented the plaintiffs at trial in this medical malpractice wronful death lawsuit.  

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