This case involves a 60-year-old woman who suffered from atrial fibrillation for which her cardiologist had prescribed her Xarelto. She planned to undergo an outpatient colonoscopy procedure after experiencing lower abdominal pain, and the gastroenterologist informed patient that she should stop using Xarelto two days prior to the procedure. This instruction was given to the patient without consulting with her cardiologist. After the colonoscopy procedure was performed, she went back on Xarelto later that night. However, early the next morning she suffered a stroke and was taken to the emergency room. She recovered, but subsequently suffered paralysis on the left side of her body. It is alleged that the patient’s cardiologist should have been consulted which would have promoted him to inform the gastroenterologist that patient should have only been taken off the Xarelto for no more than one day.
Question(s) For Expert Witness
- 1. Do you have extensive experience performing colonoscopies?
- 2. How soon before the procedure should a patient go off anticoagulant drugs (e.g. Xarelto)?
- 3. Would you typically consult a patient's cardiologist or PCP prior to stopping an anticoagulant in a patient with a history of atrial fibrillation?
- 4. Are you familiar with the complications that can occur when a patient not correctly taking Xarelto pre and post colonoscopy?
- 5. Please explain your experience working on similar cases.
Expert Witness Response E-006838
I have extensive experience performing colonoscopies. Patients taking anticoagulants should discontinue them 1 day prior to undergoing a colonoscopy. It is not typical or necessary to consult the patient’s cardiologist before stopping anticoagulation prior to a colonoscopy. I am familiar with and can discuss the potential complications that may occur when a patient is not compliant with Xarelto pre and post colonoscopy. I have worked on several cases related to complications following a colonoscopy.
Expert Witness Response E-004817
I have been performing colonoscopies for over 30 years. Gastroenterology literature recommends 24 hours in patient with normal renal function (eGFR > 50) with direct factor X inhibitors like Xarelto. A consultation is not required for low risk procedures like colonoscopy. Strokes, thromboembolic complications, bleeding and death are all complications associated with improperly taking Xarelto pre and post-colonoscopy. This case should have had the patient off anticoagulation 24 hours with reinstitution the evening post procedure based on information presented.