GMA story this morning

[901]

This morning on GMA they ran a story about pharmacies issuing the wrong dose because they let the help (that aren't pharmacists) actually fill the prescriptions.
The story claimed that a woman was on coumadin and mistakenly received a 10X dose of Coumadin. Because of the overdose, she had a stroke and eventually passed away.
Is it possible to have a stroke from a Coumadin overdose? I thought the concern with overdosing was bleeds and that strokes could only occur from underdosing.
I figured that since I'm not a Coumadin expert, I didn't want to go popping off to Dr. Tim Johnson about their story having major conflicting information.

 

[catwoman]

Maybe a cerebral hemorrhage? Website says "massive stroke."

Website says an employee, a high school student, mistyped the dosage on the label as 10X what the doctor had ordered.

I **always** double-check my prescriptions, whether filled locally or by Medco Health.

 

[Blanche]

Too much Coumadin can cause internal bleeding any where in the body, including the brain, which is also known as a stroke. Too little Coumadin can cause stroke too. That's what happened to my husband in 2000.
Blanche

 

[Marty]

There are two types of strokes. Cerebral thrombosis where one of the blood vessels gets a clot, which obstructs blood flow to an area in the brain is most common and anticoagulant therapy helps prevent this. The other kind of stroke, cerebral hemorrhage, is where a blood vessel bursts and blood floods into an area of brain.While this type of stroke is less common in general I think we folks on warfarin have a higher incidence than the general population.There are problems with low INR but also problems with high INR.

 

[lance]

How tragic

How tragic

It's surprising the patient herself didn't notice the difference in the amount of warfin she was given. She probably didn't home test and complied with with the instructions on the vial. It's very tragic.

The problem with ACT is warfarin.

 

[Ross]

The problem with ACT is warfarin.

Warfarin isn't the problem. When taken as it should be taken, it's relatively safe. The problem with ACT is that too many people do not know what they are doing and their dosing people wrong or stupid things like the above happen.

 

[Guest]

When I dispensed prescriptions in a retail pharmacy, I tried to always ask the person to open the container and see if what was inside was what they actually thought that they ordered. Even people who did not speak my language could shake their head ?No? if that wasn?t what they thought that they ordered.

 

[Marty]

1 mgm warfarin per day

1 mgm warfarin per day

I saw 20/20 last night.

The patient harmed was a cancer patient and was prescribed 1 mg warfarin per day. Unusual? She was given 10 mgm tablets. Who is prescribed 1 mgm tablets? At my clinic they are prescribed for cancer patients who have Porta-Cath tubes going in through an arm vein into the big vein near the heart, the superior vena cava. These catheters are used to give chemotherapy. I asked one of the oncologists why they prescribe such a tiny dose. She said an article in their literature recommended it to keep the Porta-Cath from clotting and it seems to work. As far as I know, these patients on 1 mgm per day are not monitored with regular prothrombin times.The woman in 20/20, who apparently suffered a cerebral hemorrhage, and was mistakenly taking 10 mgms warfarin per day was probably never monitored!

 

[Guest]

I asked the oncologists what they do for people who need less than 1 mg per day. They started referring them to me for monitoring.

 

[tommy]

I noticed on my last antibiotic prescription, the text on the paperwork descrbed the pill. I thought that this was a great way to confirm that I had the right stuff.

But that doesn't solve the problem of a typo in transcribing the doctors order into the pharmacy computer. I would expect the pharmacist to view the history and see the mismatch.

Again the patient should have a clue about what they are taking.

 

[Marty]

I asked the oncologists what they do for people who need less than 1 mg per day. They started referring them to me for monitoring.

Seriously, Al, are you referred these 1 mgm warfarin per day cancer patients with Porta caths and PCC lines for monitoring?