Clive Hyman

I am Sarah Bourke, HM Assistant Coroner for the coroner area of Inner North London.

On 21 August 2025, Senior Coroner Hassell commenced an investigation into  the death of Clive Mark Hyman aged 64 years. The investigation concluded at the end of the inquest on 13 January 2026. The conclusion of the inquest was that “ Mr Hyman presented with severe brain injuries a few days after falling and hitting his head. He died in hospital on 10  August 2025”. I returned a conclusion that death was due to accident. The medical cause of death was: 1a traumatic subdural haemorrhage  (operated); 2 atrial fibrillation (treated with apixaban), coronary artery bypass graft.

Mr Hyman was 64 years old, active and in good general health. He was  prescribed apixaban following treatment for atrial fibrillation and a coronary  artery bypass graft. On 1 August 2025, Mr Hyman tripped on the stairs whilst  making a telephone call. He informed his colleague that he had hit his head but  was feeling “fine”. He subsequently told his wife about falling on some marble  steps. Mr Hyman did not seek medical advice following the fall. Neither he nor  his wife was aware that taking apixaban presented a risk in relation to head  trauma. Mr Hyman presented normally until 1 pm on 5 August 2025 when he  developed a sudden, severe headache. His blood pressure was also extremely  high. His wife called the ambulance service and was told that it was a “non- emergency”. Mr Hyman took some paracetamol and went to bed. Around 3.45  pm, his wife heard him choking. She saw that he had vomited and was  unresponsive. A further call was made to the ambulance service, paramedics  attended and conveyed Mr Hyman to his local emergency department. A CT  scan revealed that Mr Hyman had a left-sided subdural haemorrhage. He was  given prothrombin and tranexamic acid to help reverse apixaban and given  hypertonic saline prior to being transferred to the regional trauma centre. Mr  Hyman underwent an emergency left-sided decompressive craniectomy on  arrival which was uneventful. He was transferred to the adult critical care unit.  A CT scan taken on 6 August showed that Mr Hyman had bleeding within the  pons and changes consistent with an ischaemic stroke. Sedation was withdrawn on 8 August, but Mr Hyman continued to have a profoundly decreased level of  consciousness. Further imaging on 9 August established that he had had an  extensive stroke affecting the entirety of the left hemisphere of the brain.  Neurosurgeons advised that the prospects of any meaningful recovery were  poor. Mr Hyman died in the early hours of 10 August.

ORONER’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 could occur unless  action is taken. In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows. 1)  NICE guidelines NG232 on the Assessment and Early Management of  Head Injury state at paragraph 1.2.1 “ Public health literature and other non-medical sources of advice … should encourage people who have any concerns after a head injury … to seek immediate medical advice .   Paragraphs 1.2.3 and 1.2.4 of the guidance state that remote advice services and community health services “should refer people who have  sustained a head injury to a hospital emergency department … if there  are any of these risk factors … current anticoagulant or antiplatelet  (except aspirin monotherapy) treatment ” 2)  Having reviewed several patient information leaflets issued with  apixaban, it is evident that patients are routinely advised not to take the drug if they are “bleeding excessively”. In addition, they are advised to  seek medical advice if they are at “increased risk of bleeding”. None of  the patient information leaflets that I reviewed expressly addressed the steps to be taken by a patient if they sustain trauma to the head. 3)  Patients who have experienced head trauma may not realise that they have sustained an intracranial bleed.  As head injuries can be  asymptomatic for some time following trauma, apixaban users may  continue taking the medication and avoid seeking medical advice  because they feel well. As a result of taking apixaban, bleeding may  continue. By the time symptoms of a brain injury emerge (e.g. a sudden, severe headache) the patient may be critically ill and have a reduced  potential for recovery.

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