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Supratherapeutic warfarin without bleeding — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Supratherapeutic warfarin without bleedingUSMLE Step 3

A 73-year-old woman presents 3 weeks after starting warfarin for atrial fibrillation. INR is 8.6. She has mild bruising but no bleeding. Hemoglobin is 12.7 g/dL, platelets are 240,000/mm3, creatinine is 0.9 mg/dL, and stool guaiac test is negative. 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: B — Hold warfarin and give oral vitamin K

Markedly elevated INR without major bleeding is managed by holding warfarin and giving oral vitamin K depending on INR and bleeding risk. Reversal with PCC is reserved for serious or life-threatening bleeding.

Reference: CHEST Antithrombotic Therapy Guidelines