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Warfarin-associated subdural haematoma — SCE Geriatric Medicine MCQ

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HardFallsWarfarin-associated subdural haematomaSCE Geriatric Medicine

An 88-year-old woman with moderate dementia is admitted after a fall with head injury. She takes warfarin for a mechanical mitral valve; INR is 3.8 and CT head shows a small acute subdural haematoma. GCS is 14, BP 168/84 mmHg and neurosurgery advises conservative management. What is the most important next step?

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

Intracranial haemorrhage on warfarin requires urgent reversal, even when managed conservatively, because expansion risk is clinically significant. The mechanical valve creates later thrombosis-management complexity, but it does not negate the immediate need to control bleeding. Aspirin or therapeutic heparin would worsen haemorrhage at this point. The pearl is that anticoagulation decisions can be sequential: reverse life-threatening bleeding first, then plan re-anticoagulation with specialists.

Reference: NICE head injury guidance; BNF; British Society for Haematology anticoagulation reversal guidance