Popular blood thinner causing deaths, injuries in nursing homes

[mahatmakanejeeves]

Popular blood thinner causing deaths, injuries in nursing homes

Health & Science
By Charles Ornstein | ProPublica July 12 at 10:47 PM

When Loren Peters arrived in the emergency room in October 2013, bruises covered his frail body and blood oozed from his gums. ... The 85-year-old had not been in a fight or fallen down. Instead, he had been given too much of a popular, decades-old blood thinner that, unmonitored, can turn from a lifesaver into a killer.

“My goodness, I’ve never seen anything like it,” recalled Lorna Finch, Peters’s daughter, of the ugly purple bruise that sprawled from the middle of her father’s stomach to his hip. “It was just awful.”

Peters took Coumadin at his Marshalltown, Iowa, nursing home because he had an abnormal heart rhythm, which increases the risk of stroke. It’s a common precaution, but the drug must be carefully calibrated: too much, and you can bleed uncontrollably; too little, and you can develop life-threatening clots.

When nursing homes fail to maintain this delicate balance, it puts patients in danger. From 2011 to 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin, a ProPublica analysis of government inspection reports shows. Studies suggest there are thousands more injuries every year that are never investigated by the government.

[backscatter712]

1. Wafarin is potentially dangerous stuff.

Obviously, in the correct dose, it's useful and life-saving, but bear in mind that in super-high doses, it's literally rat poison.

[Wellstone ruled]

11. Warfarin is the same as Rat Poison.

[MADem]

2. Aspirin added to coumadin can be the problem, as well. nt

[SidDithers]

3. As with so many things, the dose makes the poison...nt

Sid

[Vinca]

4. This is the tip of the iceberg.

Old people are routinely given too many meds at too large a dose and drugs seem to only be added and never taken away.

[glinda]

6. That is so true. I had to keep on the Hospitals and

facilities to make sure they didn't add things back on. Came across lots of Dr. errors or staff errors. Things are really messed up imho.

[Vinca]

8. You really have to keep on top of things and investigate your condition and its treatments.

Many old people grew up in an era when doctors were considered gods and are less likely to speak up and question what is being given to them.

[polly7]

18. Absolutely true.

My own mother believes that the doctor who failed to diagnose my Dad's illness, which was a big part in not treating it soon enough is still some sort of god. Most older people take exactly what they're given without question, and often don't understand that unusual reactions, either short or long-term, require them to have their meds re-evaluated. Every older person needs a medical advocate.

[KamaAina]

9. Often on purpose.

Nursing homes routinely sedate patients to keep them docile.

[polly7]

10. Yes, they do .... and years, sometimes decades of takiing these drugs leave many of these residents

with horrific effects. It's very sad to watch.

[backscatter712]

12. The scary thing is that wafarin is not a sedative.

It's a blood thinner, that's also used as rat poison.

And there are so many idiots working in nursing homes with prescription authority that it's inevitable that one of those idiots will raise a resident's wafarin dose to "quiet him down".

[polly7]

16. No, it's not a sedative.

But the amount and dosage of psychotropic - antipsychotics, antidepressants, benzo's, etc. piled onto a resident's daily med intake by visiting doctors who see them for, sometimes literally seconds, and see any slight change in behaviour as something needing to be further controlled medically has always made me ill. I worked in nursing homes as a SCA for many years - you could always tell which drugs those slumped over in chairs nearly completely unaware, those with facial tics, involuntary movement of the mouth and tongue, full body spasms, were on. Family members occasionally would plead with the charge nurse to lessen or stop the number of meds their relatives were taking daily, but of course it was the doctor's decision, and very, very difficult for those from a distance to meet with him on the day he swooped in and out. Much easier to 'control' them than provide therapy and involve them in programs that utilized the abilities they still had, were it not for being medicated to the point of becoming nearly catatonic.

Warfarin also is extremely dangerous if not used and monitored properly, as the OP points out, for the obvious reasons. I wish every elderly or disadvantaged resident had an advocate who understood these things. Very many are completely on their own, having lost all siblings and friends, and with no children, or none nearby to help. It's heartbreaking to see, actually.

[uppityperson]

17. What? Who is working in a nursing home with prescriptive authority?

Med errors happen in the greater world also and anyone who would mistakenly increase an anti-coagulant with the hopes of sedating someone needs their license revoked. I am not sure what this has to do with nursing homes.

[FlatBaroque]

15. As a former

Exec. Dir of an assisted living facility, I can confirm that when I admitted a typica resident, s/he might move in with up to 25 prescriptions. There is a shortage of primary care doctors who will regularly monitor medications.

[BrotherIvan]

25. Exactly

If a person sees multiple doctors/specialists, they will not monitor or discuss what another doctor prescribes. My mother's excellent pharmacist spent so much time checking everything I am very grateful. When I finally went with her to each doctor and went through each prescription and asked them to specifically state why she was on it, she was able to stop 13 medications that were not necessary. THIRTEEN!!!!! It is scandalous.

[FlatBaroque]

27. Your mom

Will be rewarded by your vigilance. The pharma sector is a rarely addresses problem.

[BrotherIvan]

29. Thank you, she passed away two years ago

It helps to have an advocate come with someone, especially an elderly person, to doctor's appointments. People really have to ask questions.

[City Lights]

5. My dad was on Coumadin before he died and it was awful.

He had a horrible time staying regulated and was constantly having to have blood drawn and then having to change his dosage. He hated it. I hated it.

[Thinkingabout]

7. There are also some foods which are blood thinners. Blueberries are very healthy but can thin the

blood. Sunflower seeds, turmeric, and so many more. I know as you age the skin becomes thinner and any bump can cause a bruise and perhaps just from a small bump on safety rails, etc can result in bruising with those who take Coumadin. It is supposed to be monitored. Also, if there is even a minor illness lowering of small blood platelets can result in more bruising.

[SheilaT]

13. I have a lot of trouble understanding why every single old

person who sees a doctor regularly is on blood thinners. Or close to every one.

[Igel]

21. It shouldn't be every one.

If you have heart arrythmias or certain other disorders you can form clots. Those can cause lung problems, block arteries in the extremities, or cause strokes. Arrhythmias are very common in older people. You need echocardiograms or other tests to see if clots are forming in the heart as a result of arrythmias, and those require special equipment, a lab tech to do the test, and some body else to evaluate the results. Certain kinds of problems with veins and arteries can lead to roughness that can promote clots. Inactivity can cause phlebitis, and older folk are often relatively immobile. Heart attacks can produce clots. Clots are bad news. Warfarin blocks clot formation and help dissolve clots that have formed.


But warfarin also counterindicated if you're at greater risk of stroke than clots, because if you're on warfarin and have a stroke, you're pretty much done. And it needs to be monitored very closely.

[SheilaT]

22. It shouldn't be, and surely it is not every one.

But I don't think I've met very few people over the age of 70 who aren't on it.

When I did inpatient registration at my local hospital a while back (people coming in for blood tests, x-rays, and the like) I couldn't figure out why so many of the elderly had bruises everywhere, until one patient casually commented on it.

I struggle between my medical knowledge (such as it is) that as you've pointed out blood clots are a bad thing, and what almost seems like routine ordering of blood thinners. I understand how amazing modern medicine is. Meanwhile I have a very strong belief in my body's ability to heal. I am not an anti-medicine nutcase, but I do resist a lot of it. As someone else has pointed out, people will come into nursing homes taking as many as twenty-five different medications, and I find it hard to understand why so many.

[Snobblevitch]

28. My 80+ year old father had a heart valve replaced

years ago and he has not been prescribed coumadin. Anecdotal observations are not always indicative of an entire population of an age group.

[justamama83]

14. I was on Coumadin for about 8 months

after a heart attack- it was horrible. I scratched the back of my calf - a scratch- not a cut and it bled for almost 8 hours- I was ready to go to the ER to get a shot of I think it's vitamin K they give you to clot when it stopped. I was never so happy to get off that drug. I had so many bruises I was worried people would think my husband was hitting me. I was 46 when I was on this med- I can only imagine an older person- with their much thinner skin. The blood tests and constant calibration of the pills as well as the dietary restriction were enough to make a person crazy. Sometimes the cure is worse than the disease.

[SoCalDem]

19. Sadly. the most UNDERPAID health care workers can often be found

in nursing homes. They are often overburdened with work, and doctors flit in, write a prescription and since many (most?) of their patients are uncommunicative, they suffer.

The more documented "services"/drugs/treatments they provide, the more money they make. I suspect that most of these services are unnecessary, but unless you are there physically every day who's to know?

[Igel]

20. 5 years, large population, 165 people "at least"

Not so bad. Warfarin has a decent related-death rate among those not in nursing homes because it's tricky to use and monitor. Why they should come in at 0.000% hospitalization or death while the general able-bodied population has a fairly high rate?

"Data from hospital emergency departments for 1999 through 2003 indicated that warfarin was associated with about 29 000 visits for bleeding complications per year, and it was among the drugs with the most visits. These data are consistent with literature reports of major bleeding frequencies for warfarin as high as 10% to 16%."
http://www.ncbi.nlm.nih.gov/pubmed/17620536

I took warfarin briefly. I had to go in for a checkup weekly at first. It was supposed to be less often after a few months. But every time I went in there was some problem, and there were times I'd scratch a mosquito bite and have a steady trickle of blood down my leg for an hour, until my wife noticed it. So after 5-6 months of going in weekly for a test and having my dose re-evaluated, after being sent to the hospital for more accurate immediate tests a few times--after weekly co-pays and sometimes with a hospital copay, and having my schedule interrupted for a doctor's appointment on a weekly basis, I finally said I'd had enough. I left without making an appointment and threw away my prescription when I got home. The reason for the prescription was clear--but after 3 months it was purely precautionary. Nobody wanted to run the risk of a very unlikely complication being overlooked for long enough that it could lead to a blood clot and say I could stop taking the stuff.

It's not just the dose. It's also what do you around the edges. Eat the wrong food the day before your checkup and they raise the dose because healthy leafy greens promote coagulation. Eat the wrong food, and they lower the dose. Either way, a couple of days later the dose is wrong again. Now, that's bad enough when (a) you're the patient and (b) you're the cook and (c) you're the person putting the food in your mouth and making sure you swallow. But in a nursing home, where the cook may not know every particular feature of a patient's special diet and where the patient is in charge of putting the food in his/her mouth, it's impossible. "Hey, Mabel, can I have your spinach?" Wham--your warfarin dose is off. "I don't want my spinach today." Wham--your warfarin dose is off.

[Daemonaquila]

23. All for the sake of "cost containment," of course.

Keeping people on blood thinners at the correct dose requires frequent monitoring. In most instances, people either don't get tests done, or have to make a long trip to the doctor's office over and over (and the tests aren't done on the spot so there's a delay before they'll know something is off) at high cost. There is no excuse for this when there are home INR testers, just like home glucose test kits. Why aren't they being used? Gee, insurers won't pay for it.

But they'll pay for expensive visits and reference lab testing. Even way back in the 1990s and 2000s, when I managed a medical clinic, it was a pain to be paid just for in-office tests. We could do a test in minutes, that cost $5, and have a person out the door with mods to their anticoagulants in minutes. But a number of insurers wouldn't pay for that, though they'd be happy to pay for the same test that ran $16-$30 at a reference lab, if we'd send a patient there... and get results back no sooner than 24-48 hours.

[Hoyt]

26. I've never seen Medicare deny a protime test for someone on Coumadin. They do deny the add on some

medical practices try to bill to make it look like nurse and doctor did more than draw blood and document the test results.

These were nursing homes anyway that probably didn't perform the test because it's not paid separately.

[REP]

30. I'm not on blood thinners and PT and PTT are run on me all the time

I'm not even especially old, but my doctor routinely orders coagulation (PT and PTT) studies on me. I think it's hilarious when the lab note says that my dose of Coumadin should be reduced - I'm not on any blood thinner, but I do say my blood has thinned and even California winters seem cold now.

[dembotoz]

24. Used because it works..build a better mousetrap?

Which is kinda funny considering what this drug is...