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Warfarin high INR with bleeding — GPhC CRA MCQ

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HardCardiovascular TherapeuticsWarfarin high INR with bleedingGPhC CRA

A 67-year-old woman takes warfarin for a mechanical mitral valve. She says her INR was 5.8 today and she has a nosebleed that has not stopped after 20 minutes of pressure. What is the most appropriate action?

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

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Correct answer: D — Refer urgently for medical assessment because she has bleeding with a high INR.

Bleeding with a markedly raised INR requires urgent assessment, particularly in a patient with a mechanical valve where anticoagulation management is high risk. The pharmacist should not manage this solely with routine dose omission advice. Vitamin K and tranexamic acid decisions require appropriate clinical assessment.

Reference: BNF; NICE CKS