A 68-year-old woman on long-term warfarin presents with a spontaneous intracranial haemorrhage. INR is 4.8. The most appropriate regimen for rapid reversal is:

• A Platelet concentrate plus tranexamic acid
• B Intravenous vitamin K alone
• C Fresh frozen plasma 15 mL/kg plus oral vitamin K
• D Four-factor prothrombin complex concentrate plus intravenous vitamin K ✓

Explanation

Life-threatening warfarin-associated bleeding requires immediate correction with four-factor prothrombin complex concentrate, which delivers factors II, VII, IX and X in concentrated form, followed by intravenous vitamin K 5 to 10 mg to sustain reversal as PCC effect wanes. Vitamin K alone takes 12 to 24 hours to work and is inadequate acutely. Fresh frozen plasma requires large volumes, takes time to thaw and crossmatch, and achieves incomplete INR correction compared with PCC. Platelets are irrelevant since the defect is factor deficiency, not thrombocytopaenia.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.