Prevention of Future Deaths reports · 2018

Michael Spencer

Regulation 28 report to prevent future deaths, reference 2018-0032, written 5 Feb 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report5 Feb 2018
Reference2018-0032
DeceasedMichael Spencer
CoronerAlexander Forrest
Coroner areaSouth Yorkshire (West)
CategoryAlcohol, drug and medication related deaths
Organisation namedSheffield Teaching Hospitals NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  Dr Ian Hudson, Chief Executive, Medicines and Healthcare Products 
Regulatory Agency, 151 Buckingham Palace Road, Victoria, London, 
SW1W 9SZ 

1 

CORONER 

I Alexander Forrest, Assistant Coroner, for the coroner area of South Yorkshire (West). 

2 

CORONER’S LEGAL POWERS 

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. 

3 

INVESTIGATION and INQUEST 

On 29th August 2017 I commenced an investigation into the death of Michael John 
Spencer. The investigation concluded at the end of the inquest on 31st January 2018. 
The conclusion of the inquest was 1a)  Intracerebral haemorrhage;  1b)  Rivaroaxban 
anticoagulant treatment;  2)  Ischaemic stroke (treated), Hypertension (treated). 

4 

CIRCUMSTANCES OF THE DEATH 
Michael Spencer had a fatal midbrain haemorrhage when being treated with 
Rivaroxaban as part of a clinical trial. 

5 

CORONER’S CONCERNS 

During the course of the inquest the evidence revealed matters giving rise to concern. In 
my opinion there is a risk that future deaths will occur unless action is taken. In the 
circumstances it is my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows.  –  

Rivaroxaban is one of 4 Factor Xe inhibiter anticoagulants currently available.  
Potentially fatal bleeding can take place following overdose of these drugs or following 
even relatively injury when patients are taking them.  A drug specifically designed to 
reverse the anti-coagulant effect of the Factor Xa antagonist, Andexanet alfa, is 
available in some countries which can be used in such circumstances to reverse the 
anticoagulant effect of these drugs. Evidence was given at the inquest to the effect It is 
not yet available in the UK, even for compassionate use, and that its availability could be 
lifesaving when severe bleeding occurs during treatment with Factor Xa inhibitor anti-
coagulant drugs. For the avoidance of doubt, this evidence was given in the course of a 
general explanation of the action of Rivaroxaban and the management of pathological 
bleeding during its use. It was made clear that the ready availability of Andexanet alfa 
would not have changed the outcome in Mr Spencer’s case. The concern expressed 
was in relation to the current non-availability of this specific reversal agent in the face of 
the increasing clinical use of Factor Xa inhibitor anticoagulants. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you have the 
power to take such action.  

1

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 24h April 2018. I, the coroner, may extend the period. 

Your response must contain details of action taken or proposed to be taken, setting out 
the timetable for action. Otherwise you must explain why no action is proposed. 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons; 

  The family of the late Mr Spencer 
  Chief Executive, Sheffield Teaching Hospitals Trust NHS Foundation Trust 
 
 

 Sheffield Teaching Hospitals Trust NHS Foundation Trust 
, Consultant Neurologist, Royal Hallamshire Hospital, Sheffield  

I am also under a duty to send the Chief Coroner a copy of your response.  

The Chief Coroner may publish either or both in a complete or redacted or summary 
form. He may send a copy of this report to any person who he believes may find it useful 
or of interest. You may make representations to me, the coroner, at the time of your 
response, about the release or the publication of your response by the Chief Coroner. 

9 

5th  February 2018                                                                        Alexander Forrest 

2

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