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Warfarin-associated gastrointestinal bleeding — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Warfarin-associated gastrointestinal bleedingUSMLE Step 3

A 69-year-old man with atrial fibrillation takes warfarin. INR has been therapeutic for 6 months. He develops melena and lightheadedness. Blood pressure is 88/54 mm Hg, and hemoglobin is 7.8 g/dL. INR is 4.9. Which of the following 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: D — Administer intravenous vitamin K and four-factor prothrombin complex concentrate

Life-threatening warfarin-associated bleeding requires rapid reversal with four-factor PCC plus intravenous vitamin K.

Reference: ACCP antithrombotic therapy guidance; USMLE Step 3 Content Outline