Two doctors are at the centre of a coronial inquest in Adelaide after a woman died while using the commonly prescribed blood-thinning drug warfarin.
The inquest was told that despite being 86 years old, Marjorie Irene Aston was in good health and lived independently at Woodville South in the city’s western suburbs.
A day before her death on January 5, 2013, Mrs Aston fell and hit her head.
She had been taking the drug warfarin, which was prescribed by her cardiologist.
Counsel assisting the deputy coroner Naomi Kereru said cardiologist professor John Horowitz wrote to Mrs Aston’s GP about the use of warfarin, but the note was not received until after her death.
When her GP, Dr Fong Liew, found out about the warfarin use from Mrs Aston during a home visit, he told her to stop taking it immediately.
Ms Kereru said a test, before her death, found Mrs Aston’s blood was far too thin, as the test should have recorded a International Normalised Ratio (INR) level of about two or three.
“Mrs Aston’s INR level at the time of her admission to the Royal Adelaide Hospital, just hours before her death, was 12,” she said.
“This is grossly in excess of the therapeutic level.
“While it is a medication that is frequently prescribed, placing a patient on warfarin is a very serious matter.”
She said the cardiologist had not directly contacted Dr Liew about the prescription, but had instead sent a letter, which was received on January 9, 2015.
“Following the consultation on the 19th of December, Professor Horowitz did not contact Dr Liew to inform him of Mrs Aston’s commencement on warfarin,” Ms Kereru said.
“But asked Mrs Aston to make an appointment with Dr Liew with the results of a blood test that he asked her to have on the 21st of December.”
She said an expert GP Dr Peter Joyner would give evidence later that would be critical of both doctors management of the case.