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Epistaxis on Warfarin — RACP Adult Medicine MCQ

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EasyHaematologyEpistaxis on WarfarinRACP Adult Medicine

A 75-year-old man on warfarin presents with anterior epistaxis from Little's area. Simple measures (pinching, ice, anterior packing) have controlled the bleeding. INR is 3.8 (supratherapeutic). BP is 160/95 mmHg. What is the most appropriate next step?

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Correct answer: E — Withhold warfarin, give vitamin K 1-2 mg oral, recheck INR

Anterior epistaxis controlled with packing and supratherapeutic INR (3.8) without major bleeding warrants: withhold warfarin, low-dose oral vitamin K (1-2 mg — partially reverses without fully abolishing anticoagulation), recheck INR next day. Full reversal (Prothrombinex + high-dose vitamin K) is reserved for major or life-threatening bleeding. Resume warfarin at a lower dose once INR is in range and bleeding has resolved.

Reference: Australian Blood Authority – 2024 – Warfarin Reversal; eTG Haematology 2024