Stroke After Patient Requests to Stop Warfarin
Case #174
An 82-year-old woman fell and broke her hip in 2009.
While hospitalized, she was in atrial fibrillation for several days.
She was started on warfarin.
She spontaneously converted back to sinus rhythm.
After six weeks without any recurrence, warfarin was discontinued.
She had numerous visits with her cardiologist (Dr. L) from 2010-2012.
At each visit, she reported palpitations that were intermittent.
EKGs always showed normal sinus rhythm.
Her metoprolol was adjusted several times, but given lack of evidence of atrial fibrillation, warfarin was not re-started.
At an office visit in May 2012, an EKG finally captured her in atrial fibrillation with RVR.
Her CHADS2Vasc score was 4.
Dr. L re-started her warfarin.
The patient made multiple requests to stop as many of her medications as possible.
A Holter monitor was ordered in September 2013.
It confirmed frequent episodes of atrial fibrillation, so her warfarin was continued.
During a January 2014 office visit, she continued to express desire to stop her warfarin if possible.
She was in sinus rhythm at that time.
Dr. L acquiesced and switched her to aspirin.
6 weeks later she suffered a massive stroke (details not disclosed in court documents).
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Following the stroke, she saw Dr. L again, who documented the following note:
She was severely disabled, and required nursing home care.
She died 2 years after the stroke.
The patient’s husband hired a lawyer in solo practice to bring a lawsuit against Dr. L, his medical group, and employer.
The expert witness opinion is shown below: