During 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. ; During the inquest evidence was heard that: Dorothy Delaney became patient at Alexander House Health Centre, Platt Bridge Health Centre, Rivington Avenue, Platt Bridge, Wigan in August 2013. At that time she was prescribed Clopidogrel, an antiplatelet medication, by her previous general practitioner , due to her history of transient ischaemic attack. This prescription continued to be given by her general practitioner at Alexander House Health Centre up until her death o the 110 June 2015. In March 2015 Mrs Delaney was diagnosed with atrial fibrillation and as a result was prescribed Rivoroxaban, an anticoagulant, by her general practitioner at Alexander House Health Centre, which she continued to take up until her death: iii , The Consultant Neuropathologist gave evidence during inquest that Mrs Delaney had died as consequence of spontaneous intracerebral haemorrhage which had been caused by amyloid angiopathy, which is naturally occurring disease of the vessels within the brain that can cause the vessels to rupture; resulting in haemorrhage: Evidence was given that when person who suffers from amyloid angiopathy takes anticoagulation medication there is an enhanced risk of haemorrhage occurring: The fact that Mrs Delaney was taking Rivoroxaban was determined to be a contributory factor in her death; Evidence was also given that there is an increased risk of bleeding when a person takes both antiplatelet and anticoagulant medication together . iv_ The policy adopted at Salford Royal Hospital, Salford is that if a person who is prescribed antiplatelet medication requires anticoagulation therapy, would discontinue one of the medications, in order to reduce the risk of a haemorrhage, unless there is specific reason why both should be prescribed at the same time Guidance provided by the National Institute for Health and Care for oral anticoagulation was referred to during the inquest and this guidance states that if a person is prescribed Rivoroxaban there is a increased risk 0f bleeding if anti platelet medication, such as Clopidogrel, it is taken at the same time The Guidance states that the use of both medications should be avoided, except on specialist advice_ vi Following Mrs Delaney's diagnosis of atrial fibrillation and the subsequent prescription of Rivoroxaban, no specialist advice was sought_regarding_the appropriateness of_continuing_to prescribe_ the the they both Clopidogrel and Rivoroxaban together. Evidence was given at the inquest that advice is not sought on an individual basis for patients at Alexander House Health Centre who are prescribed both Clopidogrel and Rivoroxaban as they rely on advice previously sought in respect of other patients in similar circumstances_ 1 therefore have concerns that there are patients under the care of Alexander House Health Centre who are prescribed both anticoagulation therapy and antiplatelet medication at the same time, which increases the risk of haemorrhage occurring, in circumstances where specialist advice has not been sought, taking into account the individual patient's previous medical history and circumstances.