Road rage -Pradaxa- homicide?

[Lynlw]

I agree. However this case indicates to me that warfarin, an anticoagulant with an antidote, may be less risky than Pradaxa which has none. I cannot take Pradaxa because I have mechanical valve. However my wife is also on warfarin for afib. She has decided some time ago to stay with warfarin. She has been self testing and self dosing for many years and finds it only a minor inconveniece

It is sad and terrible for everyone involved, but I don't know if it would have made a difference what anticoagulant he was on, it might have, but Since he was unconscious an hour later, shortly after he called the ambulance because his head hurt so bad, my GUESS would be the damage from the blood inside his skull pushing on his brain was already pretty major..

Altho we dont know many of the details, where the bleeding was, or what treatment he had or even if he also was on aspirin. Since he died a few days later, my guess would be it wouldnt matter which anticoagulant he was on, I THINK and even if he was on Coumadin, it still takes a few hours at least to drop the INR with Vit K and FFP, so they probably would have done the same care whether he was on any anticoagulant w/ a major brain bleed, operate or try to drain the bleeding, and use blood products, fresh frozen plasma, platelets, cryo etc
But either way it was probably too late to avoid all the brain damage by the time he passed out and got to the hospital.

Im sure the family could sue the makers of Pradaxa, some lawyers are always willing to sue, and might even win, but I think most of the trials (drug NOT court) on Pradaxa vs Coumadin showed about the same amount or more major bleeds on Coumadin than Pradaxa in Afib patients, even with out a reversal agent, maybe partly because of the much shorter half life?. Unfortunately head trauma's are worse for people on Anticoagulants, of course many people are lucky, but even if your INR is In range being on Coumadin increases the morbidity and mortality from head traumas even falls from standing.

I guess one thing to hopefully learn from this tragedy (beside don't get in stupid fights over nothing), is IF you are on any anticoagulants and have an head injury, go to an ER especially if you are starting to have pain, better safe than sorry. MAYBE IF he went to the ER, once he started having the headache they could have started things going right then, altho chances are he still would have been sitting in the ER waiting room, when he passed out, if he went to get checked after getting hit once in the head in a parking lot fight. I guess it is really lucky he went home shortly after and wasnt driving when he passed out, he could have injured other innocent people

 

[Marty]

Thanks Lyn, This is a well thought out post that just about sums up the thread. I can't add anything except to surmise that O'Brien probably had severe possibly irreversible brain damage when he complained of headache and passed out.

 

[pellicle]

wort watching, its a presentation to ER Doctors by a specialist in formulating responces to trauma patients who are on dabigatran.

http://vimeo.com/24204720

 

[Lynlw]

Thanks Lyn, This is a well thought out post that just about sums up the thread. I can't add anything except to surmise that O'Brien probably had severe possibly irreversible brain damage when he complained of headache and passed out.

Thank you. It is pretty sad for everyone, I'm sure a man like Mr Cena seems to be will really feel guilt over another persons death, not to mention both families.
Here is a pretty recent article describing the risks of bleeds on Coumadin as well as the newer anticoagulants trials results. Toward the end it mentions rates of brain bleeds with even minor "trauma" hmmm that direct link doesnt work, since it is my pdf, , I think you can read the PDF from this http://www.ncbi.nlm.nih.gov/pubmed/24019755 where it says free article or here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760283/

Speaking about head trauma, in Mr Obrien's case specifically, I was wondering If when he passed out he hit his head and caused even more damage

 

[Marty]

Thanks Pellicle, This is a remarkable video that shows ER people have been doing a lot of thinking about people who come to the ER bleeding and who are taking dabigatrin. The ER doctor must asess the severity of the bleeding and find out when the patient took his last dose.. With a 13 hour half life it may be best not to do anything.Blood test APTT and TT if normal indicate little or no anticoagulation.
If treatment is indicated administer FFP or ViiA if available. In cases of severe bleeding dialysis.

 

[Marty]

Lyn, Thanks for the references. Detailed discussion. Every ER doctor should know whats in these articles, like the young ER doctor in Pellicle's video.

 

[ottagal]

A personal Pradaxa ER story:
My father has had a few bouts of afib, as well as previous bypass and colon CA surgery. When he was visiting us a few years ago , he was visibly short of breath and feeling quite weak. We brought him to the ER where they did a full work up on him. The final diagnosis was that he was severely anemic, presumably from a GI bleed related to the colon issues and underwent blood transfusions. Before he was released, I brought up with the emerg. doctor that he was on Pradaxa and was wondering if his internal bleed could be due to this. That is when the 'lightbulb' went on and they told him to discontinue the Pradaxa immediately.

Within a few months the issue resolved itself. Because the afib was not a regular occurrence and he is on numerous cardiac meds (including aspirin), they never put him back on the Pradaxa. Luckily, his ER story had a happy ending.
P.S. I was surprised that I had to bring up the Pradaxa issue with them.