Emergency INR Correction Target — FRCA Final MCQ

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

ModerateTrauma & Emergency AnaesthesiaEmergency INR Correction TargetFRCA Final

A 55-year-old man (ASA III) on warfarin for mechanical mitral valve requires emergency surgery for bowel obstruction. His INR is 4.5. After administering PCC and vitamin K, what INR target should be achieved before proceeding?

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

Reveal the answer and explanation

Correct answer: A — <1.5

For emergency surgery requiring normal haemostasis, the INR should be corrected to <1.5 using PCC (fastest) and IV vitamin K 5 mg (sustained effect). In mechanical valve patients, anticoagulation should be restarted as soon as surgically safe (typically 12-24 hours post-operatively) due to the high thrombotic risk. Bridging with unfractionated heparin infusion (easily titratable, short half-life) is often used until the INR returns to therapeutic range. The cardiology team should be involved in the anticoagulation plan.

Reference: Association of Anaesthetists – 2025 – Blood components; BSH – 2020 – Warfarin reversal