KMJ (a patient through his son and litigation friend) v Cardiff and Vale University Health Board (formerly Cardiff and Vale NHS Trust)

At the age of 40, the Claimant (date of birth 24 February 1964) suffered a deep vein thrombosis after which he was started on long-term warfarin. In April 2006, his general practitioner stopped the warfarin. On 10 December 2006, the Claimant experienced severe pain in his right calf. He was taken by ambulance to the University Hospital of Wales where he was diagnosed with acute ischaemia caused by an arterial occlusion. The Claimant was treated with thrombolytics along with intravenous heparin. Blood tests prior to the infusion were within normal limits. Record keeping of the administration of the heparin was poor, but it was noted that the dosage of heparin was entered twice on the chart to start at 5000 IU in 45ml sodium chloride. The syringe/bag would have been changed at approximately 05:00 and 14:50 h on 11 December 2006 and approximately 01:00 h on 12 December 2006. The activated partial thromboplastin time (clotting time) was measured at 22:35 h on 10 December 2006 and 10:00 h on 11 December 2006 and noted as within the desired range at 38 and 41 s, respectively. During the evening of 11 December 2006, the femoral sheath was checked and moderate oozing of fresh blood noted in an untimed entry. No action was taken in response to this. At about 05:00 h on 12 December 2006, the Claimant developed a headache and began vomiting. He was reviewed at 07:00 h, and a doctor suspected an intracranial haemorrhage, which was confirmed with a subsequent computed tomography scan. A blood test taken at 07:34 h showed an APTT of greater than 240 s (the norm being 22–33 s). The heparin infusion was stopped at 09:00 h, and blood tests taken at 09:34 h confirmed the prolonged APPT. It was noted ‘Heparin overdosed’. The Claimant was given fresh frozen plasma, and an external ventricular drain was inserted. Protamine was given at approximately 13:30 h.