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Warfarin-Related ICH — RACP Adult Medicine MCQ

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ModerateEmergency MedicineWarfarin-Related ICHRACP Adult Medicine

A 68-year-old man on warfarin for a prosthetic mitral valve develops a large right-sided intracerebral haemorrhage. His INR is 4.2 and GCS is 10. What is the most appropriate immediate reversal strategy?

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Correct answer: D — Prothrombinex-VF (3-factor PCC) plus IV vitamin K 5–10 mg

Life-threatening warfarin-associated intracranial haemorrhage requires emergent reversal with Prothrombinex-VF (prothrombin complex concentrate – 25–50 IU/kg, dose based on INR) PLUS IV vitamin K 5–10 mg (slow infusion). PCC provides immediate reversal (minutes) while vitamin K provides sustained effect (6–8 hours). FFP alone is insufficient due to volume required and slow correction. Target INR <1.5 as rapidly as possible.

Reference: eTG – 2025 – Haematology; NHMRC – 2024 – Blood Administration Guidelines