Finding into death of Carl David Waldon

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

A 64-year-old man died from intracerebral haemorrhage along a deep brain stimulator wire tract four days after elective neurosurgery 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 prescribed enoxaparin dose (120mg twice daily) exceeded the guideline-recommended dose for his lean body weight (107mg twice daily); antiXa levels were not checked at appropriate timepoints to verify therapeutic range; specialist haematology oversight was not obtained despite obesity and renal impairment making enoxaparin pharmacokinetics unpredictable. An alternative strategy—delaying DBS until a Watchman device insertion for atrial fibrillation—was identified but not pursued. Clinicians should calculate anticoagulation doses by lean body weight in obese patients, obtain specialist oversight for complex cases, and monitor antiXa levels appropriately.