skip to main content

Warfarin-associated intracranial haemorrhage — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardNeurology and ophthalmologyWarfarin-associated intracranial haemorrhageSCE Acute Medicine

A 72-year-old woman on warfarin for a mechanical mitral valve presents with headache and vomiting after a fall. CT head shows acute subdural haemorrhage with 6 mm midline shift. INR is 5.8. What is the most appropriate next step in management?

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

Reveal the answer and explanation

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

Life-threatening intracranial haemorrhage on warfarin requires immediate reversal with PCC plus IV vitamin K, alongside neurosurgical referral. Mechanical valve thrombosis risk is important later, but it does not outweigh emergency haemorrhage control. Oral vitamin K or delayed correction is too slow.

Reference: British Society for Haematology Warfarin Reversal Guidance; NICE CKS Anticoagulation