Mismanaged Coumadin (Warfarin) Therapy Results in Patient's Death

Case Overview

This case takes place in Rhode Island and involves a man in his early 60’s who had been prescribed Coumadin by his cardiologist. Subsequently, he required a prostate biopsy. The biopsy was coordinated between his urologist and his cardiologist regarding concerns of augmenting or eliminating Coumadin therapy in advance of the procedure. The use of Coumadin therapy was continued and sadly, due to this mismanaged Coumadin therapy, the patient bled out and died immediately following the procedure.

Questions to the Urology expert and their responses

Do you routinely perform prostate biopsies?

I do perform prostate needle biopsies on a regular basis.

If so, have you performed prostate biopsies on patients who're on Coumadin therapy?

I probably have done so on patients who are on Coumadin, but cannot recall a specific case.

Are there any specific steps that must be taken to ensure adequate therapeutic levels of Coumadin in a patient with this profile, to avoid the outcome described above?

Patients are routinely told to stop the Coumadin at least four to seven days prior to the procedure, and their INR's are tested to be sure that they are in the safe range.

Have you ever had a patient develop this outcome?

I have never had such an outcome and have rarely seen a patient with prolonged bleeding after this procedure.

About the expert

This board-certified expert currently serves as Associate Professor of Urology at a major university medical center and part of the medical staff of a medical center and health care system. He earned a BA from the University of Rochester, and an MD from the University of Maryland. He completed residency training in general surgery at University of Illinois at Chicago/Cook County Hospital. He is a member of numerous prestigious societies in the urological field. In addition to publishing several journal articles and book chapters, he actively reviews articles in scientific journals such as the Journal of Urology and the Journal of Sexual Medicine.