Wed3November0919PM 6

A 70-year-old male is admitted with haematemesis and hypotension. He is currently being treated with warfarin for atrial fibrillation and his INR returns as 10.

Which of the following is the most appropriate immediate treatment of his INR?

(Please select 1 option)

Fresh frozen plasma

Intravenous vitamin K

Cryoprecipitate

Prothrombin complex concentrate and vit K Correct

Oral vitamin K

Explanation

This gentleman is having a potentially life-threatening bleed in the setting of a grossly elevated INR.

Due to his warfarin therapy, he will have reduced levels of factors II, VII, IX, and X and requires replacement to correct his INR rapidly. This is most effectively achieved by the administration of prothrombin complex concentrate (Beriplex or Octaplex, 25-50 units/kg IV) and vitamin K.

These result in complete reversal of the warfarin-induced anticoagulation within 10 minutes, but the clotting factors have a finite half-life and therefore 5 mg IV vitamin K should be given at the same time.

Fresh frozen plasma (FFP) contains more dilute clotting factors and therefore produces inferior correction and should not be used in the management of life-threatening bleeding (unless prothrombin complex concentrate is not available).

Cryoprecipitate and oral vitamin K are not recommended for the management of life-threatening bleeding.

Reference:

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

Answer Statistics

1

4%

2

8%

3

1%

4

89%

5

1%

Times answered: 270