A 70-year-old man on warfarin has a haemorrhagic stroke and an INR of 8.0. What is the most appropriate immediate reversal?
Answer and explanation
Correct answer: A. Prothrombin complex concentrate with intravenous vitamin K
- Step 1: Life-threatening bleeding on warfarin needs rapid reversal.
- Step 2: Prothrombin complex concentrate replaces clotting factors quickly, and IV vitamin K gives lasting reversal.
Answer
Prothrombin complex concentrate with intravenous vitamin K.
Why not the others: Withholding the next dose of warfarin and repeating the INR tomorrow: Stopping a dose does nothing for an active bleed. Fresh frozen plasma alone, given slowly over 12 hours: Plasma alone takes longer and needs large volumes. Oral vitamin K 1 mg with a repeat INR in 48 hours: Oral vitamin K is too slow for major bleeding.
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