Our claims team secured a defense verdict on behalf of a nephrologist, a nephrology professional corporation, and a nurse practitioner in a case involving the alleged wrongful death of a 53 year old patient involving the discontinuation of antiplatelet therapy in order that a renal biopsy be performed.

The descendant-plaintiff had a history of myocardial infarction at 48 years old for which he received a percutaneous transluminal coronary angioplasty with stent placement. At age 50, the patient had another drug-eluting stent placed for his coronary artery disease. For the 3 years following the placement of the last stent, the patient was maintained on a combination of aspirin and Plavix, and on May 29th, the patient was seen by the defendant-nephrologist for renal failure. The nephrologist informed the patient that he would need a kidney biopsy due to the extent of proteinuria found on his urinalysis. The nephrologist documented:

5/29 Treatment plan: Needs biopsy – waiting cardiac clearance. To stop ASA/Plavix.
6/2 Addendum: D/w patient’s cardiologist, Plavix /ASA can hold for 10-12 days. Shall restart 2 -3 days after biopsy.

On June 2nd, under the direction of the nephrologist, the patient was seen by his cardiologist to obtain clearance for the renal biopsy. The cardiologist spoke with the nephrologist documenting: “…it is safe to hold antiplatelet therapy prior to undergoing renal biopsy, however, he should have prompt reinitiation of antiplatelet agent.”

The day after discussing the case with the cardiologist, the nephrologist ordered a CT guided renal biopsy which was scheduled for June 6th. The patient did not obtain the biopsy due to prior authorization issues with his health insurance. On June 7th, the plaintiff was brought to the emergency department where he died from an arrhythmia due to an alleged myocardial infarction.

The decedent’s wife brought suit against the parties involved alleging that the cessation of dual antiplatelet therapy led directly to a stent thrombosis resulting in the death of her husband.

At trial, our defense team was able to show that obtaining a kidney biopsy was the appropriate course of action given that the patient had nephrotic range proteinuria. The defense showed that the defendant-nephrologist appropriately sought the advice of the patient’s cardiologist regarding the management of the patient’s cardiac medications – including the dual antiplatelet therapy regimen. The defendant-nephrologist documented his conversation with the cardiologist in the chart and appropriately discontinued the antiplatelet medications. While some contended that the length of dual antiplatelet therapy interruption of 10-14 days was too long, the defense was able to show that the patient did not actually stop antiplatelet therapy until June 2nd; therefore, the patient was at most, 5 days without the medication. Since most experts conceded that 5 days was appropriate, the defense was able to prove that, even under the plaintiff’s standards, the patient had not been exposed to an excessive interruption of therapy. Additionally, the decedent had been on dual antiplatelet therapy for 3 years post stent placement. This duration of therapy is in excess of the guidelines, even for a drug eluting stent. Finally, the defense was able to use information gathered at autopsy to show that the patient did not have a stent thrombosis but rather likely had an arrhythmia from myocardial scarring associated with the decedent’s heart attack 5 years prior and was therefore wholly unrelated to the patient’s antiplatelet medications. In the end, the jury unanimously agreed with the case put forth by our defense team and a defense verdict was rendered.

**Although the disposition of this claim predates the formation of EmPRO, the management of the claim was handled by EmPRO’s management company (PRIMMA, LLC). To learn more about the EmPRO story, click here.