Emergency Warfarin Reversal — FRCA Final MCQ

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

ModerateTrauma & Emergency AnaesthesiaEmergency Warfarin ReversalFRCA Final

A 62-year-old man with a mechanical mitral valve is taking warfarin and has an INR of 3.2. He develops an acute abdomen requiring emergency laparotomy that cannot be delayed for 6–12 hours. Which is the most appropriate immediate warfarin-reversal regimen?

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

Reveal the answer and explanation

Correct answer: A — Four-factor prothrombin complex concentrate with intravenous vitamin K

Four-factor prothrombin complex concentrate (PCC) with intravenous vitamin K is the appropriate regimen. PCC rapidly replaces factors II, VII, IX and X; for Beriplex, an INR of 3.2 corresponds to approximately 25 IU of factor IX per kg, with INR correction commonly achieved within about 30 minutes. Intravenous vitamin K provides sustained reversal but takes approximately 4–6 hours to act, so it is inadequate alone when surgery cannot wait. Fresh frozen plasma is not recommended for routine vitamin K antagonist reversal and requires a substantially larger volume. Recombinant factor VIIa does not replace all warfarin-depleted factors, while tranexamic acid inhibits fibrinolysis without reversing warfarin. The mechanical valve increases thrombotic risk but does not preclude necessary reversal; anticoagulation should be reconsidered promptly once haemostasis permits.

Reference: Konakion MM 10 mg/ml solution for injection, Summary of Product Characteristics, section 4.2: Reversal of anticoagulation prior to surgery, checked 2026. https://www.medicines.org.uk/emc/product/9755/smpc