I have previously written about misdiagnosis of stroke on this blog. When stroke is not timely diagnosed, the patient misses out on time-sensitive treatments that can preserve brain tissue, such as tPA (a “clot buster” medication) or thromboembolectomy (where a blood clot is removed through a surgical procedure). However, in many circumstances, blood clots that shut off the flow of blood to the brain can be avoided altogether. A recent study published in the Journal of the American Medical Association (JAMA) reports that doctors often are not doing enough to prevent strokes caused by blood clots.
Most strokes caused by blood clots result from the buildup of plaque in the arteries that supply blood to the brain. This process, called atherosclerosis, occurs in many Americans as they get older. Physicians are trained to screen for this condition by listening for abnormal blood flow in the carotid and vertebral arteries. Using ultrasound imaging, physicians can monitor the degree of occlusion in these arteries. There are well-established indications for surgery when the occlusive disease gets severe enough to put the patient at risk of blood clots developing in the artery that will prevent adequate blood flow to brain cells.
Another common source of blood clots that can obstruct blood flow to the brain arises out of a heart condition called atrial fibrillation (or “A Fib”). A Fib affects about 2% of Americans under age 65 and about 9% of Americans over age 65. A Fib is caused by irregular heartbeats that cause dizziness, shortness of breath, fatigue, heart palpitation and chest discomfort. Besides making A Fib sufferers uncomfortable, A Fib also increases the risk for blood clots. This occurs because as the heart beats irregularly, blood can pool and form clots in the heart. Then, when the heart beats again, the blood clot can be expelled from the heart where it travels to the brain and causes a stroke.
A Fib is a well-known condition of which every competent doctor should be aware. Further, there is a well-known treatment available to prevent strokes in this patient population. Depending on risk factors, patients can be prescribed an anticoagulant (e.g., warfarin) which prevents clot formation in A Fib sufferers. However, the JAMA study published in March 2017 reports that 85% of patients who should be prescribed medicine to prevent clot formation are not being prescribed the medication. As an Ohio medical malpractice lawyer, I find this study extremely disturbing.
Under Ohio law, a medical malpractice or medical negligence claim arises when a doctor fails to practice in accordance with accepted standards of medical care. In modern medicine, it is simply unacceptable for a physician or nurse practitioner to fail to prescribe antithrombotic (clot preventing) medications to high risk patients with A Fib to reduce their risk of stroke. Put simply, this is negligent care and, unfortunately, it appears to be widespread.
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