March 18, 2013

162017_132140396847214_292624_nClarence Clemons was the well-known and very talented saxophonist with Bruce Springsteen’s E Street Band for many years. When Clarence Clemons died at the age of 71 in June 2011, it was reported that he died as a result of complications from a stroke. As it turns out, he had had carpal tunnel surgery due to his loss of sensation in his index finger and thumb that affected his ability to play the saxophone. The day following his successful surgery, he was reportedly found by his wife beside his bed on the floor and he was unable to speak properly.

Clarence Clemons was not a healthy man at the time of his death – in the past, he had had a minor heart attack, had undergone spinal fusion surgery, had several joints replaced, and had suffered from retinal detachment. At the time of his carpal tunnel surgery, he had been taking blood thinners. He was reportedly advised to stop taking his blood thinner medication before his surgery but was not given other medications, such as Lovenox, either before or after his carpal tunnel surgery.

Clarence Clemons’ brother filed a medical malpractice case against three physicians associated with the Palm Beach Cancer Center (Clarence Clemons did not have cancer at the time of his death) alleging that they negligently advised him to stop taking his blood thinners before the surgery and failed to prescribe Lovenox before or after the carpal tunnel surgery, which allegedly led to his stroke and his resulting death. The surgeon who performed the carpal tunnel surgery was not named as a medical malpractice defendant in the lawsuit. The medical malpractice lawsuit was filed last year at which time it was sealed from public viewing but was approved in February 2013 to proceed to a public jury trial.


Blood Thinners And Hand Surgery

INR (International Normalized Ratio) is the ratio of the Prothrombin Time (“PT” – a measure of clotting; normal is approximately 11 to 13 seconds) for a sample of a patient’s blood to what is considered normal Prothrombin Time. The “normal” INR is 0.8 to 1.1 and an INR range of 2.0 to 3.0 is generally effective for people taking warfarin (coumadin) who need full anticoagulation but may need to be slightly higher in certain situations.

A study reported in The Journal of Hand Surgery published by the American Society for Surgery of the Hand in 2004 found that for 39 patients receiving warfarin (a common blood thinner) with an INR of  between 1.3 and 2.9 who had a total of 55 hand procedures without changing the dosing of warfarin (which included carpal tunnel release surgery as well as other hand surgeries) experienced no problems with bleeding during surgery (two patients were reported to have had minor bleeding-related complications that did not require further surgery and did not result in any long-term problems). The authors of the study stated that “Interruption of anticoagulation in patients taking coumadin for atrial fibrillation, a mechanical heart valve, or previous thromboembolism may pose an increased risk for a thromboembolic event. Temporary cessation of warfarin and administration of low-molecular weight heparin is a proven means of manipulating anticoagulation peri-operatively, but can be difficult to effectively coordinate in an outpatient setting … interruption of warfarin therapy in hand surgery is unnecessary if the INR is less than 3.0.”


If you or someone you know who takes blood thinners such as coumadin suffered a stroke or other complication during or following surgery, you should promptly contact a local medical malpractice attorney to investigate whether medical negligence was a cause of your injuries and represent you in a medical malpractice case, if appropriate.

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