Critical care: warfarin reversal in life-threatening bleeding: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Critical care: warfarin reversal in life-threatening bleeding

Sample item

A patient on warfarin has a life-threatening intracranial haemorrhage with an INR of 5. Which is the preferred reversal?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Four-factor prothrombin complex concentrate with intravenous vitamin K

Prothrombin complex concentrate replaces factors II, VII, IX and X immediately and is preferred to plasma for urgent reversal. Intravenous vitamin K is given with it to sustain the effect once the concentrate wears off. Oral vitamin K alone acts too slowly.

Option by option

  • A. Four-factor prothrombin complex concentrate with intravenous vitamin K (correct)

    Correct. Concentrate gives immediate reversal and vitamin K sustains it.

  • B. Protamine

    Protamine reverses heparin and not warfarin.

  • C. Platelet transfusion alone

    Platelets do not reverse warfarin.

  • D. Vitamin K orally alone

    Oral vitamin K takes many hours.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Four-factor prothrombin complex concentrate with intravenous vitamin K. Prothrombin complex concentrate replaces factors II, VII, IX and X immediately and is preferred to plasma for urgent reversal.

Why is "Protamine" not the answer?

Protamine reverses heparin and not warfarin.

Why is "Platelet transfusion alone" not the answer?

Platelets do not reverse warfarin.

Why is "Vitamin K orally alone" not the answer?

Oral vitamin K takes many hours.

What concept does this question test?

It tests Critical care: warfarin reversal in life-threatening bleeding in Anaesthesia. Intravenous vitamin K is given with it to sustain the effect once the concentrate wears off. Oral vitamin K alone acts too slowly.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Critical care: warfarin reversal in life-threatening bleeding?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.