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Warfarin reversal for traumatic subdural haematoma — FRCA Final MCQ

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ModerateTrauma and Emergency AnaesthesiaWarfarin reversal for traumatic subdural haematomaFRCA Final

A 76-year-old woman on warfarin falls downstairs and needs urgent craniotomy for acute subdural haematoma. GCS is 8, INR is 3.4, pupils are unequal, and CT shows midline shift. What is the most important next step?

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Reveal the answer and explanation

Correct answer: A — Give four-factor prothrombin complex concentrate with intravenous vitamin K

Warfarin-associated intracranial haemorrhage requiring emergency surgery needs rapid reversal with four-factor PCC plus intravenous vitamin K. Fresh frozen plasma is slower and larger volume. Platelets do not reverse warfarin anticoagulation. Tranexamic acid may have roles in bleeding care but is not warfarin reversal.

Reference: NICE head injury guidance; BSH warfarin reversal guidance