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Anticoagulation Bridging — RACP Adult Medicine MCQ

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HardClinical PharmacologyAnticoagulation BridgingRACP Adult Medicine

A 70-year-old man with a metallic aortic valve on warfarin requires urgent hip surgery for a fracture. His INR is 3.2. What bridging strategy is most appropriate?

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Correct answer: A — Cease warfarin, give Prothrombinex-VF, commence therapeutic UFH

For urgent surgery in a patient on warfarin with a mechanical valve (high thrombotic risk), rapid reversal with Prothrombinex-VF (25–50 IU/kg) plus low-dose vitamin K (1–2 mg IV) is required to achieve INR <1.5 for surgery. Therapeutic heparin bridging (UFH infusion) should be commenced post-operatively when haemostasis is secured, as mechanical valves carry high thrombotic risk. Warfarin is restarted when the patient is eating.

Reference: eTG – 2025 – Haematology; CSANZ – 2019 – Anticoagulation Bridging Guidelines