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Warfarin-associated intracranial bleeding — RACP Adult Medicine MCQ

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HardClinical pharmacology and toxicologyWarfarin-associated intracranial bleedingRACP Adult Medicine

A 76-year-old man taking warfarin for a mechanical aortic valve presents after a fall. CT brain shows acute subdural haemorrhage and INR is 4.8. He is drowsy but protecting his airway. What is the most appropriate management?

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Correct answer: D — Give intravenous vitamin K and four-factor prothrombin complex concentrate urgently

Major intracranial bleeding on warfarin requires urgent reversal with PCC and IV vitamin K, balancing later thrombosis risk. Observation or oral vitamin K alone is too slow. Alteplase and aspirin would worsen bleeding and do not reverse warfarin.

Reference: Thrombosis and Haemostasis Society of Australia and New Zealand guidance; AMH