Sun21November0420PM 20

A 70-year-old man is commenced on a course of warfarin for a femoral vein thrombosis.

He presents to the Emergency department with abdominal pain, hypotension and a pulsatile abdominal mass. Urgent coagulation studies show an international normalised ratio (INR) of 4.1.

What is the most important first line treatment to reverse his anticoagulation?

(Please select 1 option)

Fresh frozen plasma

Factor VII concentrate

Cryoprecipitate

Prothrombin complex Correct

Intravenous vitamin K

Explanation

This is a ruptured abdominal aortic aneurysm and urgent correction of the coagulopathy is essential.

Warfarin inhibits synthesis of vitamin K dependent clotting factors (II, VII, IX and X), hence the replacement of these with prothrombin complex is the fastest way to reverse the INR.

Fresh frozen plasma contains such small quantities of these factors that vast volumes would be required to make any meaningful difference.

Vitamin K provides longer term reversal but works slowly (several hours).

Cryoprecipitate contains fibrinogen, factor VIII, factor XIII and von Willebrand factor. It is most commonly used to treat disseminated intravascular coagulation.

Factor VII concentrate will solve only part of the problem. The effects of prothrombin complex last only a few hours as the factors are used up so further dosing or treatment with other agents may be required.

Reference:

Keeling D, Baglin T, Tait C, et al. Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol. 2011;154:311-24.

Answer Statistics

1

7%

2

2%

3

2%

4

84%

5

8%

Times answered: 295