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 20th, 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 bleeding.
He said the risk factors for brain haemorrhages were age and coagulation therapy.
"The insults that give rise to a subdural haemorrhages in a person on warfarin can be something as trivial as shaking your head, nodding yes or no 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 the more likely 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, a branch of St Brendan's Hospital and a residential care centre for people with psychiatric difficulties. On July 18th, 2005, her room mate reported that Ms Foran, who was on warfarin due to a blood clot on the lung, had slumped and fallen.
CT scans revealed a brain haemorrhage, and she was pronounced dead on July 20th, 2005.
Her GP, Dr Mark Whitty, said she had been prescribed a penicillin antibiotic as the drug does not cause too much difficulties with people on warfarin. Her nephew, Michael Foran, queried whether the warfarin was being monitored. The GP said she was being checked at the Mater Hospital but that results are not always passed on to him.
The jury passed a verdict of death by misadventure, giving the cause as a subdural haemorrhage with warfarin as a principal factor.