By Neely Cotten, ACNP, MSN

The Annals of Pharmacotherapy recently published a research study that raises concern for anyone involved in the review and analysis of medical claims.

The study estimated that seven percent of all medication errors are made in the administration and monitoring of blood thinners. That makes this class of drug the second most likely to be associated with administration and monitoring error.

Since 2005, the FDA has approved nine blood-thinning prescription medications.  If you’re reviewing a claim involving irregular heartbeat, stroke, and blood clots, you had better be well-versed in the behavior and side effects of these powerful drugs. Source: http://www.apsf.org/newsletters/html/2012/spring/05_anticoagulant.htm

Since 2005, the FDA has approved nine blood-thinning prescription medications. If you’re reviewing a claim involving irregular heartbeat, stroke, and blood clots, you had better be well-versed in the behavior and side effects of these powerful drugs.
Source: http://www.apsf.org/newsletters/html/2012/spring/05_anticoagulant.htm

While the last generation of anticoagulants have specific lab values to monitor their effects, scientists have not yet developed correlating tests for each new drug.  This is something that adds to the burden for anyone handling a claim.

The back story

In the not-so-distant past, practitioners prescribing anti-coagulants had just two choices — heparin or warfarin. The FDA approval of Lovenox, a new low-molecular weight heparin, revolutionized the medical world in the early 90’s. Patients receiving heparin and warfarin required inpatient administration or strict phlebotomy schedules and rigid dietary restrictions as outpatients to prevent bleeding complications. Lovenox made it possible for patients with clotting disorders to self-administer their medications at home with no outpatient blood work required. The safety, efficacy and low risk of complications associated with Lovenox changed how physicians treated their patients.

Despite the progress made in this new generation of blood thinners, the side effects of unmonitored anticoagulants can be dangerous and potentially devastating.  The most common side effect is uncontrollable bleeding. Such episodes have spurred researchers to create new drugs that act on different portions of the body’s clotting cascade.

Within the past ten years, new blood-thinning medications have flooded the market.  Aging Boomers, their doctors and others now face a daunting list of names, mechanisms of action, and monitoring parameters for these complex, life-or-death medications.

The relative scarcity of data on this new generation of anticoagulants raises serious concerns for patients and providers alike.  That’s because the efficacy and side effects of the medications are potentially un-measureable.

Why is this important?

Today, the management of irregular heartbeat, stroke, and blood clots requires an unprecedented level of expertise.  It also ups what is required for anyone to review an insurance claim.

Cases of medical malpractice can be won or lost by your understanding of the monitoring parameters for anticoagulants. For example, imagine that a patient experiences a cerebral hemorrhage, or brain bleed, after receiving the anticoagulant Xarelto.

If I were reviewing a claim as a Legal Nurse Consultant, I would ask:

  • Did the physician fail to adequately monitor the patient’s bleeding times in order to prevent this?
  • Was this is an unforeseeable event?

What would you do?  Would you ask these and other questions?  More important, what conclusions might you draw from the responses you got?

Neely Cotten, ACNP, MSN is a Legal Nurse Consultant with MKC Medical Management. Contact Neely at neely@mkcmedicalmanagement.com or 865-551-6800.