Patient Suffers Stroke After Being Taken Off Anticoagulant

ByWendy Ketner, M.D.

|

Updated onFebruary 19, 2019

Patient Suffers Stroke After Being Taken Off Anticoagulant

This case involves a female patient who suffered a massive stroke. Prior to the stroke, the patient was on Coumadin for atrial fibrillation. However, the medication was stopped two months before the patient’s stroke after she experienced bleeding from a puncture wound. The wound originated from a renal artery stent that was surgically repaired with no further bleeding. An expert cardiologist was sought to discuss whether taking a patient with atrial fibrillation off an anticoagulant for a prolonged period of time was within the standard of care.

Question(s) For Expert Witness

1. Do you treat patients with atrial fibrillation routinely?

2. Is it normal for a patient with atrial fibrillation who has no bleeding from a prior surgical procedure to have his anticoagulation stopped for a prolonged period of time? Please explain.

Expert Witness Response E-044112

inline imageI am board certified in cardiac electrophysiology and hold a Ph.D. in pharmacology as well. I am a clinical instructor at my institution, and I commonly prescribe anticoagulants in the AF. I would not hold anticoagulants for this period of time, especially in patients with high CHADS2-VASc scores unless the risk of bleeding was very high. Having said that, there are some questions I have on the case. I would want to know the nature of the stroke (ischemic vs. hemorrhagic), the age of the patient, and CHADS2-VASc / HAS-BLED score. In order to render a thorough opinion, I would also need to know whether the AF was valvular or nonvalvular, whether the patient had a mechanical valve or recent stent (when was the renal stent placed, etc.) and whether she was on antiplatelet drugs. I would also want to know the site of bleeding (arteriotomy or perinephric, etc.). I'm assuming it was a groin stick bleed that required vascular repair.

About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

Find an expert witness near you

What State is your case in?

What party are you representing?