BLOOD THINNERS – A WORLD OF PROBLEMS
We had a case last year where a woman went to a Nursing / Rehab facility after a Knee Replacement for rehab. Of course, her orthopedic surgeon felt that Blood thinners would be a good idea to prevent problems such as clots while she underwent therapy.
When the woman arrived at the nursing home, the NH physician ordered a different dose of blood thinners. The nurse, didn’t write either order down – so our patient went weeks without blood thinners. Someone realized the mistake, ordered a dose, and scheduled to take the patients PT/INR. (PT/INR stands for Prothrombin time (PT) which evaluates the ability of blood to clot properly, it can be used to help diagnose bleeding. INR stands for The International Normalized Ratio (INR) is used to monitor the effectiveness of blood thinning drugs).
When her PT/INR was not within the accepted range, the blood thinner dose was changed. This process of course takes days: 1. blood test day 1. Lab result day 3. Change dose day 4, etc.
The sad conclusion was that our patient had a blood clot that became a pulmonary embolism, which eventually took her life.
Today’s Wall Street Journal cites a new report in the New England Journal of Medicine, that claims genes could influence what would be the ideal dose of an anti-coagulation medication.
One argument against testing patients genetic code, is cost. Apparently it costs $400 per test. Well I would argue, the 12 hours our client spent in ICU and the emergent attempts to stop the blood clot from spreading to her lungs, likely cost more than $400. The physician’s attorneys fees certainly cost more than $400 and the value of my client’s life, could never be measured.