‘Coughing could kill people taking blood thinning drug’

A COUGH could cause a brain haemorrhage in people taking a common blood thinning treatment, an inquest heard yesterday.

The Dublin City Coroner’s Court heard that Elizabeth Foran, 68, was being prescribed warfarin, an anti-coagulant used to prevent blood clots from forming or growing larger, by the clinic at the Mater Hospital before her death on July 20, 2005.

Dr Paul Downey, who carried out the autopsy, said the pensioner had a brain haemorrhage and had International Normalised Ratio (INR) levels well above those recommended. A rise in the INR level results in an increase in the risk of serious bleeding.

He said the risk factors for brain haemorrhages were increased age and coagulation therapy.

“The incidents that give rise to subdural haemorrhages in a person on warfarin can be something as trivial as nodding your head or coughing,” he said, on people whose INR levels have gone out of control while on the therapy.

Dr Downey said the raised levels were more likely the cause of the bleed than her age.

He said: “Monitoring levels of warfarin is a delicate balancing act, some people can be very sensitive to it.”

Ms Foran was a patient at St Elizabeth’s Court, NCR, Dublin 7, a branch of St Brendan’s Hospital, a residential care centre for people with psychiatric difficulties. On July 18, 2005, her room mate reported that Ms Foran, who was on warfarin due to a blood clot on the lung, had fallen.

CT scans revealed a brain haemorrhage, and she was pronounced dead in hospitalon July 20, 2005.

Her GP, Dr Mark Whitty, said she had been prescribed a penicillin anti-biotic for a condition on her leg as the drug does not cause too much difficulties with people on warfarin. On July 4, Dr Whitty said he extended the prescription of antibiotics for another seven days.

Dr Whitty said he was surprised at the high INR levels detected in Ms Foran.

Her nephew, Michael Foran, queried whether the warfarin was being monitored. The GP said she was being checked on a fortnightly basis by the warfarin clinic at the Mater Hospital.

Dr Downey said: “My belief is the principle cause of death is the warfarin therapy not withstanding the bruise on the forehead.”

The jury passed a verdict of death by misadventure.