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Lumbar puncture while anticoagulated — SCE Acute Medicine MCQ

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EasyProcedural Knowledge in Acute MedicineLumbar puncture while anticoagulatedSCE Acute Medicine

A 58-year-old woman presents with a procedure-related acute decision. Relevant history includes coagulation, imaging, respiratory physiology or procedural risk. On assessment, bedside findings determine whether the procedure is safe and urgent. Investigations show LP considered for SAH but INR is 3.1 on warfarin. What is the most appropriate next step in management?

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

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Correct answer: A — Do not perform LP until anticoagulation is reversed or safe alternative imaging is arranged

The key discriminator is that LP considered for SAH but INR is 3.1 on warfarin, which makes Do not perform LP until anticoagulation is reversed or safe alternative imaging is arranged the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Call critical care for escalation and Give targeted antidote or reversal therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: ABN LP guideline; BNF warfarin reversal