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Warfarin Reversal for Major Bleeding — RACP Adult Medicine MCQ

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ModerateHaematologyWarfarin Reversal for Major BleedingRACP Adult Medicine

A 70-year-old man with a mechanical mitral valve on warfarin (INR 3.2) presents with a large spontaneous rectus sheath haematoma. Hb drops from 135 to 85 g/L. He is haemodynamically stable. What is the most appropriate reversal strategy?

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Reveal the answer and explanation

Correct answer: D — IV vitamin K 5 mg plus Prothrombinex (PCC)

Significant bleeding on warfarin (major haemorrhage with Hb drop >20 g/L) requires urgent reversal with IV vitamin K (5 mg slow infusion) plus Prothrombinex (PCC — 3- or 4-factor, dosed by INR and weight per Australian Blood Authority guidelines). PCC provides immediate factor replacement while vitamin K ensures sustained reversal (onset 6–8 hours). FFP alone is inferior.

Reference: Australian Blood Authority – 2024 – Warfarin Reversal; NBA Bleeding Guidelines