A fifty year-old man entered the Emergency Department with severe abdominal pain. Three years earlier he had undergone liver transplantation from a donor on life support who had collapsed suddenly with subsequent brain death. A year after his transplant he had a blood clot on his lung after knee surgery. He was on blood thinners for three months. Shortly thereafter he developed a blood clot in a large vein in his pelvis resulting in massive leg swelling. He was advised to be on blood thinners for life. He was never evaluated as to a cause for these clots.
Ten days prior to this ED visit he was admitted to the hospital for rectal bleeding. His blood thinners were stopped and he was given Vitamin K as an antidote to Warfarin. Colonoscopy revealed bleeding hemorrhoids. The bleeding stopped spontaneously and he was discharged. The hospitalist physician caring for him on the day of discharge told him on his way out the door to check with his family doctor about resuming his blood thinners. He called that office and spoke with the receptionist who, after putting him on hold for two minutes, told him not to resume the blood thinners until he saw the doctor. After receiving Vitamin K his anticoagulation had been completely reversed and he had no blood thinner in his system. His family doctor did not know this.
Upon admission to the hospital he was found to have a blood clot in the main vein draining the small intestine (superior mesenteric vein). He was given blood thinners and then taken to surgery. Most of his small bowel was considered non-viable by the surgeon despite the rapid reinstitution of anticoagulants. He underwent removal of most of his small intestine and has been unable to take in enough calories to survive without developing life-threatening diarrhea. He will be on intravenous feedings for life at a cost of over a hundred thousand dollars per year.
He has filed suit against the hospitalist who discharged him and his primary care physician for the advice given over the phone. The suit is ongoing.