A patient on warfarin has INR > 6 with no active bleeding. The most appropriate management is:

• A Administer intravenous protamine sulfate
• B Stop warfarin and administer low-dose oral vitamin K1 (phytomenadione 1-2.5 mg) ✓
• C Administer fresh frozen plasma immediately
• D Continue warfarin at a lower dose and repeat INR in 24 hours

Explanation

For an elevated INR (>5 but without significant or life-threatening bleeding), current guidelines (BCSH, AHA) recommend withholding warfarin and administering low-dose oral vitamin K (1-2.5 mg) to gradually restore INR to the therapeutic range. Protamine reverses heparin, not warfarin. FFP and prothrombin complex concentrate (PCC) are reserved for active major bleeding or emergency surgery. Continuing warfarin even at lower dose is inappropriate when INR is supratherapeutic.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.