A 60-year-old man on long-term anticoagulation with warfarin (INR 3.5) requires emergency appendicectomy. He is otherwise haemodynamically stable. The optimal strategy to reverse anticoagulation before surgery is:

• A Withhold warfarin and wait 48–72 hours until INR <1.5
• B Vitamin K 10 mg IV plus 4-factor prothrombin complex concentrate (4F-PCC) for rapid reversal ✓
• C Fresh frozen plasma (FFP) alone — 4 units IV
• D Protamine sulphate IV

Explanation

For emergency surgery in a patient on warfarin with a supratherapeutic INR, the fastest reversal is achieved with 4-factor prothrombin complex concentrate (4F-PCC: factors II, VII, IX, X) plus intravenous vitamin K. FFP alone is slow to take effect, requires large volumes, and carries risks of volume overload and TRALI. Protamine sulphate reverses heparin, not warfarin.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.