Did a Failure to Prescribe Anticoagulation Result in a Stroke?


Did a failure to prescribe Anticoagulation result in a stroke?  A case requiring review by a Cardiology Expert Witness.


Atrial fibrillation is a common medical condition with complex treatment options. Medical malpractice cases regarding atrial fibrillation frequently require cardiology medical expert witnesses.  A leading cardiology medical expert is the key to success in these difficult cases.


A 32-year-old man with atrial fibrillation was under the care of a cardiologist who referred him to a cardiac electrophysiologist for permanent pacemaker placement.  While under the care of the cardiac electrophysiologist (“EP specialist”), he was never instructed to take aspirin or any other anticoagulant therapy.  Several months later, while awaiting pacemaker placement, he suffered a debilitating stroke resulting in left-sided hemiparesis. The client contacted Elite Medical Experts to secure a leading cardiology medical expert witness.

Elite’s Role

As a part of our case consultation, our internal physician-led team realized that the scope of this case fell outside of the realm of a general practicing cardiology medical expert. The client required a clinical cardiac electrophysiology medical expert to independently review the medical records in order to determine what occurred as only an electrophysiology medical expert could analyze the requisite standard of care.  The role of the electrophysiology medical expert would be able to determine whether the actions of the treating electrophysiologist deviated from the applicable standard of care.

The Medical Expert

A top electrophysiology medical expert was hand-vetted to the specific needs of this case.  The electrophysiology medical expert was a professor of clinical cardiac electrophysiology (“ep specialist”) from a major California medical university. The expert had 74 major publications and had authored 16 textbooks chapters.


The electrophysiology medical expert was able to quickly distill the relevant clinical issues though it was ultimately determined that the patient did not require anticoagulation due to a low CHADS-2 Score, an anticoagulation risk stratification tool for patients with non-valvular atrial fibrillation.  The CHADS2 score and its updated version, the CHA2DS2-VASc score, are clinical prediction rules for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation (AF), a common and serious heart arrhythmia associated with thromboembolic stroke. Such a score is used to determine whether or not treatment is required with anticoagulation therapy or antiplatelet therapy.  The CHADS2 score is simple and has been validated by many studies.

The expert contacted the client to provide an oral opinion on the merit of the claim.  The claim was subsequently dropped and the client was satisfied with the knowledge that his stroke did not occur as the result of negligence.


Looking for the right team of experts for your case? Contact Elite Medical Experts today and speak to a physician or nurse case strategist to discuss your case.

E-Case Studies are brief clinical vignettes based upon actual cases handled by Elite Medical Experts. Identifying information has been redacted or altered to protect case confidentiality.

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