Dr. Surgery performs surgical procedures every day in his office. Because he has such an elderly population base that requires anticoagulant therapy, he no longer stops such treatment prior to surgery.
He used to explain to his patients that they will have more post-surgical ecchymosis, but now he doesn’t even ask if they are on anti-coagulant therapy.
He recently performed a large excision. The patient did not take any prescription blood thinners but did take high daily doses of garlic and ginkgo. Unfortunately, the patient had progressive post-operative bleeding that led to volume loss and ultimate cardiovascular arrest. A lawsuit was brought against Dr. Surgery. Will he lose this case based on negligence?
Clearly a medication history is important for possible agents that may impair platelet function and increase risk of bleeding. The most common prescription agents that increase risk of hemorrhage or inhibit platelet function used on an outpatient basis include warfarin, low molecular weight heparin, fondaparinux, idraparinux, aspirin, clopidogrel, ticlopidine and dipyradamole.
Prescription and non-prescription nonsteroidal anti-inflammatory drugs are also commonly used and inhibit platelet function. However, the intake of herbal and vitamin supplementation is also common. The four Gs: garlic, gingko, ginseng and ginger — along with vitamin E are commonly used agents that have been implicated in increasing risk of bleeding. Should Dr. Surgery have asked about the intake of such medications?