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Supratherapeutic INR — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Supratherapeutic INRUSMLE Step 3

A 73-year-old woman taking warfarin for atrial fibrillation has an INR of 5.3 at routine monitoring. She has no bleeding, bruising, headache, or melena. Her diet and medications are reviewed; she recently completed trimethoprim-sulfamethoxazole. Hemoglobin is stable. Which of the following is the most appropriate at this time?

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

Reveal the answer and explanation

Correct answer: A — Hold warfarin and recheck the INR soon

For elevated INR without bleeding, management generally involves holding warfarin and close INR monitoring; reversal products are used for serious bleeding or very high-risk situations.

Reference: CHEST antithrombotic therapy guideline