Stroke Resulting from Mismanagement of Anticoagulation Medication: $1.25 Million Settlement
Medical Malpractice Settlement Report, 2021
By Adam R. Satin, Medical Malpractice Lawyer
Cardiologist's failure to properly manage anticoagulation medication for 57-year old patient results in debilitating stroke
This medical malpractice lawsuit involved allegations in mismanagement of oral anticoagulation therapy for a patient at risk for having a stroke.
In 2014, the plaintiff needed a hip replacement. The preoperative workup found that the patient had atrial fibrillation (“AFIB”). Patients with atrial fibrillation are at an increased risk for having a stroke due to blood clot formation in the ineffectively pumping atrium of the heart. The plaintiff was referred to the defendant cardiologist, who ordered testing that again showed AFIB. The plaintiff was started on medications to reduce the risk of dangerous blood clot formation (Xarelto, aspirin and Plavix). The aspirin and Plavix generally address the risk from his atherosclerotic coronary disease and the Xarelto was specifically to address his risk of stroke from AFIB.
Subequently, the plaintiff underwent cardioversion to reverse the AFIB. After following the patient and maintaining him on the anticoagulation regimen above for a period of time, the defendant cardiologist stopped the Xarelto after a report of some bruising by the patient’s wife. Plaintiff’s expert cardiologist indicated that the decision to stop the Xarelto was negligent in the absence of signs of severe bleeding given the patient’s risk profile.
The defendant gave cardiac clearance for the hip surgery and advised the plaintiff to stop his Plavix 5 days beforehand. The defendant resumed plaintiff’s aspirin and Plavix after the surgery, but did not resume the Xarelto. Prior to having a second hip surgery, the defendant discontinued both aspirin and Plavix.
While temporary cessation of Plavix may be done for the surgery, plaintiff’s expert was prepared to opine that discontinuation of aspirin as well was below the standard of care. Following the second hip surgery, the patient was found to have had a stroke. Plaintiff attributed the stroke to his AFIB without adequate anticoagulation.
The defendant claimed the stroke came from the patient’s documented carotid artery occlusion and that Xarelto would not have prevented a stroke that emanated from the carotids.
In response, the plaintiff found an expert neuroradiologist to challenge the report of the treating radiologist suggesting the stroke came from a carotid artery origin. Further, plaintiff was prepared to rebut the defense by offering expert cardiology testimony that continuation of aspirin alone would have avoided a stroke emanating from carotid disease.
This medical mapractice case was settled for $1.25 million.
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