A patient on warfarin has a supratherapeutic INR of 9.0 with no active bleeding. The most appropriate immediate management is:

• A Hold warfarin, administer IV vitamin K 10 mg and fresh frozen plasma
• B Administer four-factor prothrombin complex concentrate (4F-PCC) immediately
• C Hold warfarin, give oral vitamin K 1–2.5 mg and recheck INR in 24 hours ✓
• D Continue warfarin at a reduced dose and recheck INR in 48 hours

Explanation

For supratherapeutic INR (>8) without bleeding, current guidelines recommend holding warfarin and giving low-dose oral vitamin K (1–2.5 mg) to allow gradual INR correction without overshooting into a subtherapeutic range (a risk with high IV vitamin K doses). IV vitamin K and FFP/4F-PCC are reserved for active major bleeding. Continuing warfarin even at reduced dose risks further INR elevation.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.