Mr B - Non-inquest findings

84y · Male·Acute myocardial infarction precipitated by upper gastrointestinal haemorrhage from gastric ulcer in context of rivaroxaban therapy

An 84-year-old man with multiple comorbidities was prescribed rivaroxaban for deep vein thrombosis despite being a practicing Jehovah's Witness who refused blood transfusions. Rivaroxaban cannot be monitored or reversed, unlike warfarin. He developed upper gastrointestinal bleeding from a gastric ulcer, possibly exacerbated by concurrent use of a naturopathic cherry juice product and rivaroxaban. Symptoms were masked and presented as anaemia. Critical learning points: anticoagulant choice should consider patient's transfusion refusal status; clinical discharge summaries must reach GPs; a 40% haemoglobin drop warrants urgent action rather than waiting for specialist review; and symptoms of GI bleeding can be subtle in elderly patients on anticoagulants.