Coumadin (warfarin) prescription, management, and medical malpractice

Coumadin generally

Coumadin (generic name warfarin) is a prescription drug that’s a blood thinner, or anticoagulant. Warfarin has been around since the 1940s and works by reducing the formation of blood clots.

Doctors frequently write long-term prescriptions for coumadin to prevent heart attacks, strokes, or other cardiovascular conditions.

Coumadin/warfarin use doesn’t come without risks, though. The most prominent risks are that it can decrease the body’s ability to stop internal bleeding and even cause death if the dosage is incorrect.

The drug manufacturer recommends avoiding Coumadin if a patient has experienced or will experience any of the many factors that can place one at an increased risk of bleeding. These factors include things such as certain pre-existing medical conditions (like a stroke or gastrointestinal bleeding), going to the operating room for a surgery, or having a scheduled spinal tap or epidural anesthesia.

If your doctor talks about starting you on Coumadin, be sure to share your medical history, any planned surgeries or procedures, and any history that you’ve had of bleeding problems. It’s also critical that you tell your doctor about all drugs that you’re taking to avoid any potential drug interactions with Coumadin.

Coumadin/warfarin medical malpractice

There are two common types of medical malpractice related to Coumadin.

First, a doctor may be negligent by not prescribing Coumadin when you need it. Here are some of the conditions that it’s used to treat:

• A blood clot in the cardiovascular system (heart or major blood vessels) that could dislodge and cause a stroke or heart attack

• Pulmonary embolism, which is a blood clot in the lungs

• Deep vein thrombosis (DVT), which is blood clots in the deep veins of the legs

• The possibility of arrhythmia-related blood clot formation in the heart

Second, there’s negligence by not properly dosing or managing Coumadin.

One study estimated that there are around 34,000 deaths annually because of errors related to Coumadin/warfarin. Another study found that Coumadin tops the list of all drugs involved in common medication errors.

It’s easy to see how these alarming findings can be true. It all comes down to the precise pharmacology, dosing, and management necessary to give Coumadin safely to patients. Too much or too little is dangerous and potentially deadly. The dosage has to be just right.

Monitoring in nursing homes

Let’s face it, nursing home care in America isn’t that great. Even taking this into account, Texas is found near the bottom of virtually every list or study ranking nursing home care.

One study concluded, “The use of warfarin [Coumadin] in the nursing home setting presents substantial safety concerns for patients. Adverse events associated with warfarin therapy are common and often preventable in the nursing home setting.”

The most common types of bleeding events in nursing homes are ecchymoses, gross hematuria (large amounts of blood in the urine), overt and occult gastrointestinal bleeding, epistaxis, and microhematuria (small amounts of blood in the urine).

Studies have found that many Coumadin errors could be avoided in nursing homes with proper staffing and educated care-givers who pay careful attention when dispensing Coumadin (giving the correct dose) and monitoring patients, which involves doing lab work and acting on it to keep the medication at proper levels in the body.

Hospital monitoring

Coumadin errors also occur in hospitalized patients, for largely the same reasons as nursing homes, and also come up in emergency care.

In 2019, there was a large verdict of over $1 million in a case that an emergency room (ER) patient filed against a hospital.

The patient went to the hospital ER after a piece of debris cut her lower leg, broke some blood vessels, and caused a hematoma. A hematoma is a clump of blood clots found within tissues. The patient told the physician’s assistant (PA) who saw her in the ER that she was taking Coumadin every day.

According to the lawsuit, the PA and ER team didn’t treat her hematoma. Within a few hours of showing up at the ER, the PA discharged the patient with instructions to keep taking her Coumadin.

The day after she was discharged, the patient returned to the same ER because the hematoma ruptured. This time, a general surgeon evaluated her and found that she had an active bleed. Of course, the PA’s recommendation that she keep on taking the blood-thinning agent, Coumadin, didn’t help her situation. 

This medical malpractice led to her needing two more surgeries and a skin graft on her leg.

What you can do

If you’re taking Coumadin, be aware of high-risk situations and possible side effects, and speak up to a doctor or nurse if you see:

• Blood in the urine, which may appear red or brown

• Feces/stool that appears black or bloody (sometimes called black tarry stool)

• Coffee ground emesis, which is vomiting up a substance that looks like coffee grounds

• Abnormal bruising

• Coughing up blood

• Very bad stomach pain

• Severe headache

• Head injury

If you’ve been seriously injured by Coumadin/warfarin mismanagement by a doctor, hospital, or nursing home, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in reviewing your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.