This case involves a male patient who underwent orthopedic surgery for a spine condition. He was re-admitted due to wound dehiscence and underwent an additional surgery to repair the wound. The patient had a past medical history of atrial fibrillation and was on Coumadin. He was left without Coumadin in the post-surgical phase. He ultimately went on to suffer an occlusion of his coronary artery, which caused a significant myocardial infarction with septal defect all requiring open heart surgery, as well as an ischemic stroke.
Question(s) For Expert Witness
- 1. Do you routinely treat patients like the one described in this case?
- 2. Have you ever had a patient develop the outcome described in this case?
Expert Witness Response E-007419
I have and continue to routinely treat and have treated multiple patient’s such as the individual in this case. I personally have not experienced an outcome in any of my patients but have reviewed similar cases treated by other physicians. I do believe that the patient would have had a better outcome had appropriate care and rendered. My experiences have included working in the cardiac catheterization lab for 25 years, attending on the inpatient cardiology services, extensive experience in the outpatient clinics, and providing consultations. In addition I have been the director of the coronary care unit and Vice-Chair of clinical medicine in the Department of Internal Medicine. I was the director of cardiovascular training for over 25 years and have been actively involved and teaching of medical students, interns, residents and cardiovascular follows. I was also involved in clinical research during my initial 10 or 15 years on the faculty.
Expert Witness Response E-000218
I routinely treat these type of patients, as I manage atrial fibrillation and give advice regarding pre/intra and post operative management of anticoagulation. The factors that are key here are that an appropriate risk assessment of the stroke risk vs. bleeding risk occurred. The CHADS2VASC score assesses stroke risk, and the surgical situation determines bleeding risk.