Failure To Prescribe Coumadin: $1 Million Settlement
Lawsuit claims failure of cardiologist and nurse practitioner to prescribe Coumadin to patient with atrial fibrillation results in stroke
2026 Medical Malpractice Lawyer’s Report
By Krysia Syska, Attorney for the Plaintiff
Middlesex Superior Court, Massachusetts
Case summary
The plaintiff was a then 59-year-old woman with a history of atrial flutter and hypertension, who remained under the ongoing treatment of the defendant cardiologist and defendant primary-care nurse practitioner for several years. Throughout this period, the patient experienced recurrent episodes of atrial flutter and atrial fibrillation, requiring frequent office visits and adjustments to antiarrhythmic medication. Despite these repeated episodes and the presence of established stroke-risk factors, neither defendant assessed or applied the CHA₂DS₂-VASc scoring tool to determine her risk of embolic stroke, nor did either recommend or initiate anticoagulation therapy.
From 2010 through 2018, the cardiology provider consistently documented recurrent palpitations, arrhythmia, and elevated blood pressure, yet continued the existing treatment plan without advising anticoagulation. The patient’s risk profile—female gender and hypertension—placed her at a CHA₂DS₂-VASc score of 2 early in the course, increasing to 3 when she turned 65 in 2016. Under accepted standards of care, a score of 2 or higher mandates consideration and initiation of anticoagulation to reduce the risk of cardioembolic stroke. Despite this, no such medication was ordered, and the cardiology provider did not conduct periodic examinations when renewing antiarrhythmic prescriptions to ensure the adequacy and safety of the ongoing treatment plan.
Similarly, during multiple annual examinations between 2013 and 2018, the nurse practitioner documented the patient’s persistent atrial flutter and hypertension. Each visit confirmed that the patient was not receiving anticoagulation. Nevertheless, the nurse practitioner did not calculate a CHA₂DS₂-VASc score, did not appreciate the patient’s elevated stroke risk, and did not recommend anticoagulant therapy in accordance with established standards for managing atrial flutter. The nurse practitioner also renewed cardiac medications without directing the patient back to cardiology for reassessment of stroke prevention measures.
On February 20, 2018, the patient presented to the emergency department with acute neurological symptoms and was diagnosed with a right occipital stroke resulting in permanent loss of left sided vision. The stroke was determined to be cardioembolic in nature, and she was started on long-term anticoagulation.
The claim alleged that the failure of both treating clinicians to recommend anticoagulation and to reassess her treatment over several years directly resulted in her preventable stroke.
The matter settled for one million dollars in the months prior to trial.
Attorneys for the plaintiff: Andrew C. Meyer, Jr. and Krysia J. Syska, Lubin & Meyer PC.
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