Lack of preoperative medication led to patient's stroke

What happened

Mr A was due to have a hernia operation in summer 2013. He was told to stop taking his usual dose of Warfarin (an oral anticoagulant) five days before his operation to avoid complications due to bleeding. Mr A went to the hospital as planned but felt unwell and left without having the operation. He said doctors told him he might need an injection of Clexane (a drug which prevents blood clots) to balance the effect of stopping Warfarin, but then decided he did not need this.

The operation was rescheduled for 12 days later. Mr A stopped taking his Warfarin again five days before the operation. He had his operation and was discharged the same day. He was not given Clexane.

Five days later Mr A was taken to hospital by ambulance with a headache and problems with his vision. He was diagnosed with a stroke and he thought this was caused by not being given Clexane.

Mr A said the stroke affected his vision, and now he is unable to drive or go outside on his own. He said this has taken away his independence, and affected his ability to care for his daughter.

What we found

There was no fault in the decision not to give Clexane to Mr A the first time he went to hospital; the Trust followed its policy correctly and the risk of stroke was low. The risk of stroke had to be balanced with the risk of bleeding which could occur if he was given Clexane.

Mr A's decision to leave the hospital without having his operation meant he had to stop taking his Warfarin for a second time when the operation was rebooked. But, as a patient, he could not be expected to know this put him at increased risk of having a stroke. There was fault in the decision not to give Clexane to Mr A the second time he went to hospital because by then, there had been two periods of Warfarin withdrawal. Not giving Mr A Clexane led to his stroke.

There was also fault in the assessment and treatment of Mr A's stroke. Assessments and a CT scan were not carried out at the correct time and there was a delay in giving Mr A aspirin. This did not affect the outcome for Mr A, but the Trust did not respond properly to this part of the complaint.

Putting it right

The Trust acknowledged and apologised to Mr A for the faults we identified and paid him £7,500. It also agreed to produce an action plan, setting out the lessons learnt from the complaint.