This case involves the death of a 55-year-old woman who was being treated for atrial fibrillation. She was prescribed Xarelto by a cardiologist, but soon started to complain of nausea, headaches and difficult bowel movements. Her concerns were not addressed by the cardiologist, and thus she found a new cardiologist 6 months later. The new cardiologist continued to prescribe Xarelto without giving a thorough assessment of her symptoms. The patient saw the new cardiologist once a month over a 5 month period, but her condition continued to decline. After a year since she was first prescribed Xarelto, she started to experience traces of a bloody stool. Not long after, the patient’s brother came to visit and found her struggling to breath. She was coughing up blood and bleeding significantly from her rectum. She was admitted to the emergency room, but medical staff could not control the bleeding and she ultimately died.
Question(s) For Expert Witness
- 1. Do you treat patients like the one described in this case?
- 2. Are you able to opine on the standard work up of someone with a history of deep vein thrombosis that develops portal vein/superior mesenteric thrombosis?
Expert Witness Response E-007567
I routinely treat patients like this one. Red flags would be changing renal function, anemia, melena or hematochezia. I routinely lecture on atrial fibrillation and all of its treatment options.
Expert Witness Response E-017257
I routinely treat patients with asymptomatic atrial fibrillation and use Xarelto, other NOACs, and coumadin to prevent stroke. Any signs and symptoms of bleeding would cause me to re-evaluate the use of anticoagulation. I have lectured extensively on NOAC use.