Alice Kuzmenko, instructed by MDDUS, recently represented two GP Partners at a complex inquest. A third GP and the hospital were also represented.

The deceased had a history of myelofibrosis (a rare blood cancer), paroxysmal atrial fibrillation, ischaemic heart disease, hypertension, and diabetes. His cancer was progressing, such that in January 2022 he had a very low platelet count and was advised by his consultant that he should stop taking his blood thinner, Apixaban, in order to minimise the risk of bleeding.

On 16th April, the patient was hospitalised. A CT scan was inconclusive, but chest x-rays showed right sided pneumonia and consolidation. The patient continued to deteriorate and by 18th April was showing signs of multi-organ failure. A further CT scan at this point revealed widespread subarachnoid haemorrhaging. On 19th April, treatment was withdrawn, and the patient passed away.

Among the issues for the inquest, the Assistant Coroner had to consider the role and effects of Apixaban, as anticoagulant medication was part of the proposed medical cause of death where there was evidence of incorrect prescription due to some human error and later policy decisions.

However, after detailed questioning and submissions, in circumstances where there was no clear evidence of whether the brain bleed was spontaneous or contributed to by Apixaban (or any other medication), and some evidence indicating that the deceased was not taking the Apixaban in the period leading up to his death, the Coroner amended the medical cause of death to omit reference to anticoagulation medication contributing to the death.

No report concerning the prevention of future deaths was made.