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Warfarin-associated traumatic subdural haematoma — SCE Acute Medicine MCQ

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HardMedicine in the ElderlyWarfarin-associated traumatic subdural haematomaSCE Acute Medicine

An 87-year-old man is admitted after a fall. He takes warfarin for a mechanical mitral valve and has a scalp haematoma but no focal neurology. INR is 4.8 and CT head shows a small acute subdural haematoma. What is the most appropriate next step in management?

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Correct answer: E — Reverse warfarin urgently with prothrombin complex concentrate and intravenous vitamin K after specialist discussion

Intracranial haemorrhage on warfarin requires urgent reversal, usually with PCC plus IV vitamin K, while involving neurosurgery and haematology given the mechanical valve. Observation alone risks expansion. Oral vitamin K is too slow for acute intracranial bleeding. The mechanical valve increases thrombotic complexity but does not remove the immediate need to control life-threatening bleeding.

Reference: NICE NG232 head injury, BSH anticoagulation reversal guidance, BNF