Marie Hilda Millward Winter · Prevention of Future Deaths report

I concluded the inquest into the death of Marie Hilda Millward Winter on 26th September 2017 and recorded that he/she died from:

1a Intracranial haemorrhage

1b Traumatic Injury

ii. Dementia Atrial Fibrillation (on Apixaban), Hypertension.

Mrs Millward Winter suffered a fall in her bedroom at the Each Step Nursing home on the morning of the 19th August 2017. It is likely that Mrs Millward Winter fell from a standing position after getting out of bed. She sustained a head injury, which was likely caused by her coming into contact with the bedside table during the fall. The head trauma led to a bleed on the brain. This bleed was increased due to Apixaban medication (which was given to Mrs Millward Winter following the fall at Each Step Nursing Home on the 19th August 2017). She was taken by ambulance to North Manchester General Hospital. The bleed was highlighted following CT scan and palliative care was provided. Mrs Millward Winter passed away at North Manchester General Hospital on the 2nd September 2017.
During the course of the inquest, I heard evidence that the care staff administered Mrs Millward Winter’s standard morning medication at around 9 am on the 19th August 2017. This medication included her regular dose of Apixaban (anticoagulant medication) 5 mg, which was prescribed to be given twice daily. I heard evidence that this medication was given to Mrs Millward Winter after the fall and after the ambulance technicians in attendance had advised that her morning medication was to be given (prior to relaying her to hospital).
On hearing the evidence of the treating clinicians at Withington hospital, I concluded that the administration of her normal dose (5 mg) of Apixaban medication, following her fall on the 19th August 2017, contributed to Mrs Millward Winter’s death. In particular, whilst the head injury itself had caused the bleed to occur, the evidence from the treating clinician at Wythenshawe Hospital was that the Apixaban increased the severity of that bleed and contributed to her death. The clinician advised that the anticoagulant should not have been given to Mrs Millward Winter at Each Step Nursing home following Mrs Millward Winter’s fall on the morning of the 19th August 2017.

The evidence was that the medication (Apixaban) was given to Mrs Millward Winter at Each Step Nursing Home on the advice of and/or in the presence of the Ambulance Technicians from North West Ambulance Service after she had sustained a head injury and prior to transporting her to hospital. The concern is that the administration of this anticoagulation medication on the morning of the 19th August 2017, following a head injury, worsened an internal bleed and contributed to Mrs Millward Winter’s death. It is of concern that such medication has been given when the patient has suffered a head injury (and is at risk of an internal bleed). It is of concern that the medication has been given on the advice of and/or in the presence of the ambulance technicians.