Warfarin-Associated Intracerebral Haemorrhage — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCerebrovascular DiseaseWarfarin-Associated Intracerebral HaemorrhageSCE Neurology

A 72-year-old man on warfarin (INR 3.8) presents with sudden onset left hemiplegia. CT head shows a large right basal ganglia intracerebral haemorrhage (60 mL). He is haemodynamically stable. What is the priority treatment to reverse his coagulopathy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Prothrombin complex concentrate and intravenous vitamin K

In warfarin-associated intracerebral haemorrhage, urgent reversal of anticoagulation is critical to prevent haematoma expansion. Prothrombin complex concentrate (PCC) provides rapid, complete reversal of warfarin (faster than FFP) and should be given with IV vitamin K (5–10 mg) for sustained reversal. A: FFP is slower and requires larger volumes with risk of fluid overload. B: Vitamin K alone takes hours to work. D: rFVIIa is not routinely recommended. E: Tranexamic acid has no proven role in warfarin-associated ICH.

Reference: RCP National Clinical Guideline for Stroke (2023); BSCH Warfarin Reversal Guidelines