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Management of anticoagulation therapy (09HDC01765)
Download Management of anticoagulation therapy (09HDC01765) (PDF 136Kb)
(09HDC01765, 15 June
General practitioner ~ District health board ~ Rural medical
practice ~ INR monitoring ~ Warfarin ~ Patient compliance ~ Patient
reviews ~ Documentation ~ Right 4(2)
A 22-year-old man underwent an urgent aortic valve replacement.
Following the heart surgery, he was placed on medication which
included an ongoing anticoagulant regime. His warfarin dosage and
INR level were to be monitored through regular blood testing and
review by his rural general practitioner and the practice staff of
his local rural medical centre.
Over the next three years the young man's INR level fluctuated
between periods of stability within a desired therapeutic range,
and periods of instability involving variable levels of compliance
which clinic staff advised him posed a serious risk to his health.
Sadly, he collapsed and died while playing social sport, aged 25.
His mother and partner complained that he had not been adequately
monitored and managed by the GP.
It was held that the GP and his staff took appropriate,
persistent, and sometimes innovative steps to inform and
communicate the importance of compliance with prescribed warfarin
doses, regular INR testing, and the risks involved if this did not
occur. When the man had a potentially harmful INR result in
mid-2008, the GP adopted a reasonable clinical course of action, to
stop the medication and then re-warfarinise.
However, it was also held that the GP failed to consistently
attend to a fundamental of good medical practice and ensure that
the clinical record was complete and adequately reviewed. Prolonged
deficiencies in documentation affected the patient's ongoing
monitoring. The GP was found to have breached Right 4(2) of the
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