Coronial

38 results for warfarin anticoagulation therapy

VICaged care2010-08-28

Finding into death of Patricia Mary Cook

85y · Female·Complications of subdural haematoma (evacuated), secondary to fall, contributed …

… complications of a subdural haematoma following a fall at a supported residential service (SRS) while on warfarin for atrial fibrillation. She fell on 30 September 2007, striking her head. Personal care attendants (PCAs…

geriatric medicineneurosurgerycommunicationsystemwarfarin
VIChospital2011-02-25

Finding into death of Michael Peysack

69y · Male·Head injury post-collapse secondary to ventricular tachycardia due to ischaemic …

Mr Peysack, a 69-year-old with complex cardiac disease on Warfarin, collapsed at work with witnessed loss of consciousness and occipital laceration. Despite meeting criteri…

emergency medicinecardiologydiagnosticcommunicationwarfarin
VIChospital2011-11-07

Finding into death of Cecil John Dunne

86y · Male·head injury (acute intracerebral haemorrhage and subarachnoid haemorrhage)

…higher risk stratification, ensure early senior review after in-hospital falls in elderly patients on anticoagulation, and implement appropriate supervision protocols for high-risk patients.

geriatric medicineemergency medicinediagnosticsystemwarfarin
SAaged care2021-06-30

Coroner's Finding: KOLAN Zygmunt

91y · Male·intracranial haemorrhage (subdural, subarachnoid and parenchymal) complicating r…

…tiple comorbidities including metastatic prostate cancer, metallic aortic valve replacement requiring anticoagulation, and pacemaker. He suffered two significant falls within two days while in respite care, the second c…

geriatric medicineneurosurgerywarfarin
SAhospital2010-02-04

Coroner's Finding: KRIVITCH Olga

81y · Female·hypovolaemic shock following bleeding from the site of a femoral angiogram

…moral angiogram puncture site. She was admitted for ischaemic leg and underwent unsuccessful thrombolytic therapy. Subsequently commenced on Heparin anticoagulation but therapeutic range took 38 hours to achieve, exposi…

vascular surgeryradiologydiagnosticmedicationheparin
WAhospital2012

Inquest into the Death of Keogh

38y · Female·Pulmonary Thromboembolism

…tectomy and splenectomy) and subsequent emergency laparotomy for septic pancreatic leak, coordinating anticoagulation with heparin and warfarin. Key issues identified: failure to obtain Bunbury's diagnostic reports and …

general surgeryintensive carecommunicationdelaywarfarin
ACThospital2019-11-04

Inquest into death of JEFFREY BROWN

72y · Male·Haemopericardium due to anti-coagulation treatment for pulmonary thromboemboliti…

Jeffrey Brown, a 72-year-old with recent cardiac surgery (CABG), died from haemopericardium due to anticoagulation treatment for pulmonary thromboembolism. Post-mortem examination revealed fibrinous pericarditis (a k…

cardiothoracic surgerycardiologywarfarin
QLDhospital2017-07-18

Stimpson, Reginald - Non-inquest findings

73y · Male·Acute intracranial haemorrhage, due to or as a consequence of coagulopathy, due …

…y emboli post-operatively after total knee replacement and was appropriately commenced on therapeutic anticoagulation with Clexane. When transitioning to oral Xarelto, the prescribing physician documented the change in …

orthopaedic surgerygeneral medicinemedicationcommunicationenoxaparin
VIChospital2021-02-05

Finding into death of Carl David Waldon

64y · Male·Left-sided intracerebral haemorrhage associated with deep brain stimulator wire …

…ery for essential tremor. He was readmitted on day 4 with suspected stroke and started on therapeutic anticoagulation (enoxaparin). A haemorrhage developed within 24 hours of dose escalation. Key clinical failures: the …

neurosurgeryneurologymedicationsystemenoxaparin
ACThome2017-03-23

AN INQUEST INTO THE DEATH OF PAP

55y · Male·Septicaemia due to hydronephrosis and infection

…cial problems died of septicaemia from renal infection. He had a history of cardiac disease requiring anticoagulation, alcohol dependence, depression, and chronic hoarding behaviour. Despite repeated hospital admissions…

cardiologypsychiatrysystemcommunicationwarfarin
WAhospital2023-03-30

Inquest into the Death of Hugh WARD

89y · Male·Complications of cerebrovascular accident (stroke); specifically a catastrophic …

…fibrillation, heart disease, diabetes, and dementia. A critical clinical challenge involved balancing anticoagulation therapy to prevent embolic stroke against his high gastrointestinal bleeding risk following gastric u…

neurologycardiologycommunicationsystemwarfarin
SAcommunity2005-10-13

Coroner's Finding: MURRAY John Matthew

35y · Male·pulmonary thromboembolism due to left deep calf vein thrombosis complicating lef…

…e was treated surgically at Royal Adelaide Hospital, Adelaide, and commenced on a specialized heparin anticoagulation protocol designed to prevent blood clots after pelvic fracture surgery. An intern doctor, Dr H., fail…

orthopaedic surgeryemergency medicinemedicationsystemheparin
QLDhospital2015-07-27

KS - Non-inquest findings

69y · Male·Intracerebral haemorrhage due to sepsis (Staphylococcus aureus bacteraemia), com…

…likely ischaemic stroke from sepsis-induced thrombosis that converted to haemorrhage, worsened by the anticoagulation. Key clinical lessons: elevated troponin requires interpretation within full clinical context; sepsis…

emergency medicinecardiologydiagnosticmedicationrivaroxaban
SAhospital2020-06-18

Coroner's Finding: THOMPSON Wayne Robert McInnes

33y · Male·Multi-organ failure due to sepsis on a background of severe ischaemic cardiomyop…

…ellulitis, requiring intensive support including ECMO and mechanical ventilation. Despite maximal medical therapy, he died three days later. The coroner found no errors in his medical care at Flinders Medical Centre or …

cardiologyintensive carewarfarin
SAhospital2005-10-13

Coroner's Finding: MURRAY John Matthew

35y · Male·pulmonary thromboembolism due to left deep calf vein thrombosis complicating lef…

John Matthew Murray, aged 35, died of pulmonary thromboembolism complicating pelvic and leg fractures sustained in a motorcycle accident. He was admitted to Royal Adelaide Hospital and underwent extensive orthopaedic sur…

orthopaedic surgerytrauma surgerymedicationsupervisionheparin
SAcommunity2015-04-24

Coroner's Finding: BYRNE Philip John and WEAVER Jacqueline

Philip Byrne: pulmonary thromboembolism due to right calf deep vein thrombosis; …

…enly 2-3 weeks later. The coroner found both deaths preventable through timely ultrasound imaging and anticoagulation. Key lessons: DVT cannot be reliably excluded clinically; calf pain without clear trauma warrants obj…

general practicephysiotherapydiagnosticcommunicationwarfarin
QLDhospital2023-06-30

Booth, Yvette and Sandy, Adele and George, Shakaya (“RHD Doomadgee Cluster”)

Female·Betty: cardiac arrhythmia complicating heart failure due to consequences of past…

…20. All three deaths were preventable through better primary health care coordination, screening, and anticoagulation management. Key systemic failures included fragmentation between Gidgee Healing (Aboriginal community…

cardiologyemergency medicinecommunicationsystempenicillin
QLDhospital2018-10-24

Statis, Joshua Ryan

12y · Male·Cardiac haemorrhage due to or as a consequence of congenital aortic stenosis (su…

Joshua Statis, a 12-year-old with complex congenital aortic stenosis, died 18 days after a redo Konno procedure and aortic valve replacement when a CardioCel patch to the right ventricular outflow tract (RVOT) ruptured, …

cardiothoracic surgerycardiologycommunicationdiagnosticwarfarin

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.