Stroke After Anticoagulation Held for Procedure [Jury Verdict for Plaintiff]
Case #204
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A 53-year-old man was referred to a colorectal surgeon for genital warts that were growing and causing pain.
The surgeon (Dr. H) recommended surgical removal.
The patient had a history of a stroke due to right internal carotid artery dissection 15 years previously.
Dr. H advised the patient to stop taking warfarin for 5 days before the procedure.
He asked the patient to discuss this temporary pause in warfarin with his physician to ensure that it was acceptable.
The procedure was done under MAC and only last 20 minutes.
However, the patient had a prolonged period of hypotension.
When he regained consciousness, he was noted to have left-side hemiplegia and mild aphasia.
Neurology was emergently consulted.
A stat CT of his head was negative for hemorrhage.
tPA was pushed within the 3.5 hour window, but did not yield any immediate improvement.
The patient was admitted.
An MRI scan revealed bilateral watershed infarcts, more prominent on the right than the left.
The patients symptoms slowly improved with therapy, but has permanent left-side weakness.
The patient filed a lawsuit making the following allegations:
The plaintiff hired a colorectal surgeon and the defense hired both a colorectal surgeon and a vascular neurologist.
Their opinions are shown here: