This case takes place in Arizona and involves a female patient who underwent a minor surgical procedure. Prior to the procedure, the patient had been receiving anti-coagulation therapy. The patient was switched to Heparin for the procedure. Some time after the procedure was performed, the patient underwent another operation on her left arm. As part of pre-surgery testing, it was determined that the patient was in danger of a major medical event. Some time after the procedure, the patient developed multiple blood clots in her arms. As a consequence of the clots, the patient lost both of her arms. It is alleged that the patient was improperly monitored and inadequately treated for her clotting.
Question(s) For Expert Witness
- 1. Do you prescribe Heparin and monitor patients on the medication? If so, how often?
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2. What protocol, if any, is in place to ensure patient safety for patient's on Heparin?
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3. What is the standard of care for preventing and treating Heparin-induced thrombocytopenia?
Expert Witness Response E-007917
I am interested in helping with this case and have no conflict of interest with the involved parties. I have a long history of published research related to heparin and just published an article on the diagnosis of HIT in the past year in the journal Chest. It’s odd that the patient developed HIT within 3 days of receiving heparin – it almost always takes at least 4-5 days for anti-platelet factor 4/heparin antibodies to form. These are the antibodies that cause the disease. One of the key aspects of monitoring for HIT involves checking the platelet count daily, especially after the 4th day of therapy. Communication is always important in any complex medical problem.
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