Smith, David Frederick

45y · Male·Haemorrhagic transformation of cerebral infarction, due to bilateral internal carotid artery thrombosis (anticoagulated), due to essential thrombocythaemia

David Smith, aged 45, died from haemorrhagic transformation of cerebral infarction secondary to essential thrombocytosis with bilateral internal carotid artery thrombosis. He developed an acute ischaemic stroke on 9 July 2019 whilst in custody at Woodford Correctional Centre and was transferred to tertiary care. Despite appropriate anticoagulation with heparin at Royal Brisbane and Women's Hospital, he suffered catastrophic haemorrhagic transformation on 20 July 2019. The coroner found his medical care in custody and in hospital was appropriate. While there were gaps in cytoreductive medication (Anagrelide) administration due to both stock unavailability and patient refusal, expert evidence confirmed these gaps were unlikely to have contributed to his death. The case highlights the management challenges in anticoagulating patients with thrombocytosis who develop ischaemic stroke whilst on antiplatelet therapy.