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Beware of Reversal of an Anticoagulated Patient with Factor IX in the Emergency Department: Case Report of a Medical-Legal Misadventure

  • Author(s): Gannon, Steven
  • Bell, David
  • Jackmiczyk, Kenneth
  • Moore, Gregory
  • et al.
Abstract

In this article we present a case of a patient who received reversal of anticoagulation therapy with factor IX in violation of hospital guidelines. As a direct result, myocardial infarction and ischemic stroke occurred, leaving the patient neurologically debilitated. Factor IX is indicated in the setting of warfarin-induced, life-threatening bleeding. The patient’s care was provided by an intern with attending physician supervision. Delayed charting and questionable shared decision-making were present in the care. We discuss usage of factor IX, liability for supervision of physicians in training, and factors that can lead to plaintiff awards.

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