PCC Warfarin Reversal Speed — FRCA Final MCQ

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EasyTrauma & Emergency AnaesthesiaPCC Warfarin Reversal SpeedFRCA Final

A 60-year-old man (ASA III) on warfarin for AF has an INR of 3.5 and requires emergency laparotomy within 2 hours. After IV vitamin K 5 mg, which product provides the fastest INR reversal?

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Correct answer: A — Prothrombin complex concentrate (PCC)

PCC provides the fastest and most reliable INR reversal for warfarin – within 10-15 minutes of administration. It contains concentrated factors II, VII, IX, and X. FFP also contains these factors but requires thawing (30 min), large volumes (15 mL/kg = ~1L), and risks volume overload and TRALI. Vitamin K provides sustained reversal but takes 6-8 hours for full effect. PCC dose is based on INR and body weight per local protocols.

Reference: Association of Anaesthetists – 2025 – Blood components guidelines; NICE – 2015 – NG24