Anticoagulant Prescription Error Claims – When Blood Thinner Medication Goes Wrong

Anticoagulants can be life-saving medicines. They can prevent a blood clot from causing a stroke, pulmonary embolism or other serious medical emergency.

However, precisely because these medicines interfere with the body’s ability to form blood clots, mistakes involving anticoagulants can also have very serious consequences.

A patient given too much anticoagulant may suffer excessive or internal bleeding. Too little medication, or an inappropriate interruption in treatment, could potentially leave a patient insufficiently protected against dangerous blood clots.

If you have suffered an injury because of an error involving warfarin, apixaban, rivaroxaban, heparin or another anticoagulant, you may want to know whether you can make a compensation claim.

What are anticoagulants?

Anticoagulants are medicines which reduce the blood’s ability to clot. They are sometimes referred to as “blood thinners”, although they do not literally make the blood thinner.

Common anticoagulants include:

• warfarin;
• apixaban;
• rivaroxaban;
• edoxaban;
• dabigatran; and
• heparin.

They may be prescribed to treat or prevent conditions including deep vein thrombosis (DVT), pulmonary embolism and stroke associated with atrial fibrillation.

The NHS guidance on anticoagulants explains their uses and some of the risks associated with treatment.

How serious are anticoagulant medication errors?

Anticoagulant errors feature prominently in clinical negligence claims involving medication.

NHS Resolution reported that between 1 April 2015 and 31 March 2020 it received 373 claims involving heparin and anticoagulant medication errors. Of those, 104 had been settled with damages when the analysis was published.

More broadly, NHS Resolution identified anticoagulants as one of the groups of medicines most commonly implicated in medication-error incidents.

What anticoagulant mistakes can happen?

Not every complication from anticoagulant treatment amounts to negligence. These medicines carry recognised risks even when correctly prescribed and administered.

A potential claim may arise, however, where avoidable harm has been caused by errors such as:

• prescribing an incorrect dose;
• dispensing the wrong strength of medication;
• administering too much anticoagulant;
• failing to consider kidney or liver function when appropriate;
• failing to monitor warfarin treatment adequately;
• failing to respond appropriately to abnormal blood-test results;
• prescribing medicines which interact adversely with an anticoagulant;
• incorrectly stopping anticoagulant treatment;
• failing to restart anticoagulants appropriately following surgery; or
• giving anticoagulant medication to the wrong patient.

Warfarin prescription and monitoring errors

Warfarin requires particular care because the correct dose can vary between patients and over time.

Patients taking warfarin normally require blood tests to establish how quickly their blood is clotting and whether their dosage remains appropriate. The NHS confirms that regular testing is required and that the dose may need changing where blood is clotting too slowly.

An error involving warfarin could potentially result in serious bleeding, including bleeding within the brain. Conversely, insufficient anticoagulation could leave a patient exposed to the condition the medication was intended to prevent.

Apixaban prescription errors

Apixaban is a commonly prescribed direct oral anticoagulant (DOAC). It is used for conditions including DVT and pulmonary embolism and to reduce stroke and clotting risks in certain patients with atrial fibrillation.

Unlike warfarin, apixaban does not generally require routine INR monitoring. That does not mean that prescribing and dispensing errors cannot occur.

The NHS identifies heavy or internal bleeding as a potentially serious side effect of apixaban.

Particular care may also be necessary when other medicines are being taken because some drugs can affect anticoagulant treatment.

What injuries could an anticoagulant error cause?

Depending upon the nature of the error, consequences could potentially include:

• gastrointestinal bleeding;
• internal haemorrhage;
• bleeding within the brain;
• severe anaemia;
• stroke;
• deep vein thrombosis;
• pulmonary embolism;
• prolonged hospitalisation; or
• in the most serious cases, death.

The crucial question in a compensation claim is not simply whether an injury occurred while taking anticoagulants. It is whether there was a negligent medication error and whether that error caused or materially contributed to the injury.

Can I claim compensation for being given the wrong anticoagulant dose?

Potentially, yes.

A successful clinical negligence claim generally requires evidence establishing both breach of duty and causation.

In practical terms, it is necessary to investigate whether the treatment fell below an acceptable professional standard and, if it did, whether the patient’s injury would probably have been avoided, or would have been materially different, with appropriate treatment.

Independent medical expert evidence will often be required.

What if the pharmacy dispensed the wrong anticoagulant?

Prescription errors do not only happen in hospitals or GP surgeries.

A prescription may be correct but the pharmacy could dispense the wrong medicine, wrong strength or wrong dosage instructions. In other circumstances, medication intended for another patient may be supplied.

Where a dispensing error causes an identifiable injury, there may be grounds to investigate a pharmacy negligence claim.

How long do I have to make a medication negligence claim?

Clinical negligence claims in England and Wales are generally subject to a three-year limitation period.

Broadly, the three years will usually run from the negligent event or from the date on which the claimant first had the necessary knowledge that an injury may be attributable to the treatment complained of.

Different provisions apply to children and people who lack the relevant mental capacity, and limitation can be a complex issue. Early specialist advice is therefore sensible.

Speak to a solicitor about an anticoagulant medication error

If you believe that you or a family member has suffered an injury following an error involving warfarin, apixaban, rivaroxaban, heparin or another anticoagulant, the circumstances can be investigated to determine whether there may be a claim.

Read more about our medication error claims  or contact Hutcheon Law for an initial assessment of your case.

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This article provides general information about the law in England and Wales. It is not a substitute for individual legal or medical advice. Patients should not stop or alter prescribed medication without appropriate medical guidance.