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Intracerebral haemorrhage on anticoagulant — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsIntracerebral haemorrhage on anticoagulantSCE Acute Medicine

A 77-year-old man is assessed on the acute medical unit. He takes warfarin and presents with headache and left-sided weakness. CT head shows intracerebral haemorrhage and INR is 4.8. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Give vitamin K and prothrombin complex concentrate

Give vitamin K and prothrombin complex concentrate is the best answer because warfarin-associated intracranial bleeding needs urgent reversal with PCC and vitamin K. Give broad-spectrum intravenous antibiotics within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: FFP is slower and less reliable for urgent warfarin reversal.

Reference: NICE NG128; BNF