Antidotes: warfarin reversal: practice question

A Pharmacology 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.

Try it

Pharmacology · Antidotes: warfarin reversal

Sample item

A 70-year-old man on warfarin, with INR 8.5, has a large intracerebral haemorrhage with deteriorating consciousness. Which management is most appropriate?

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

The answer and the reasoning

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

In life-threatening bleeding on warfarin, clotting factors II, VII, IX and X must be replaced at once with prothrombin complex concentrate, which acts faster than fresh frozen plasma. Intravenous vitamin K is added to sustain the effect once the concentrate wears off, since new factor synthesis takes hours. Oral vitamin K alone is far too slow.

Option by option

  • A. Oral vitamin K alone

    Oral vitamin K takes many hours to work and is inadequate for intracranial bleeding.

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

    Concentrate gives immediate factor replacement and vitamin K sustains it.

  • C. Stop warfarin and observe

    Observation risks haematoma expansion and death.

  • D. Protamine sulphate

    Protamine reverses heparin, not warfarin.

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.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Four-factor prothrombin complex concentrate with intravenous vitamin K. In life-threatening bleeding on warfarin, clotting factors II, VII, IX and X must be replaced at once with prothrombin complex concentrate, which acts faster than fresh frozen plasma.

Why is "Oral vitamin K alone" not the answer?

Oral vitamin K takes many hours to work and is inadequate for intracranial bleeding.

Why is "Stop warfarin and observe" not the answer?

Observation risks haematoma expansion and death.

Why is "Protamine sulphate" not the answer?

Protamine reverses heparin, not warfarin.

What concept does this question test?

It tests Antidotes: warfarin reversal in Pharmacology. Intravenous vitamin K is added to sustain the effect once the concentrate wears off, since new factor synthesis takes hours. Oral vitamin K alone is far too slow.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Antidotes: warfarin reversal?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.