Perioperative: anticoagulant management: practice question

A General Surgery 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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General Surgery · Perioperative: anticoagulant management

Sample item

A 68-year-old man with atrial fibrillation and no prior stroke takes warfarin and has an INR of 2.6. He is scheduled for an elective colectomy. What is the appropriate preoperative plan?

AContinue warfarin and give protamine on the morning of surgeryBStop warfarin the evening before surgeryCStop warfarin about 5 days before and confirm INR is 1.5 or less before surgeryDGive platelet transfusion before incision

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

The answer and the reasoning

C. Stop warfarin about 5 days before and confirm INR is 1.5 or less before surgery

Warfarin has a long effect, so it is stopped about 5 days before major elective surgery, and the INR is checked to be at or below about 1.5 before surgery. Bridging with heparin is reserved for those at the highest thrombotic risk, such as a mechanical mitral valve or recent stroke. Urgent surgery is managed with vitamin K or prothrombin complex concentrate.

Option by option

A. Continue warfarin and give protamine on the morning of surgery
Protamine reverses heparin and does not reverse warfarin.
B. Stop warfarin the evening before surgery
One day is too short for the INR to normalise.
C. Stop warfarin about 5 days before and confirm INR is 1.5 or less before surgery (correct)
Stopping 5 days earlier allows the INR to fall to a safe level for surgery.
D. Give platelet transfusion before incision
Warfarin does not reduce platelet count, and platelets do not reverse it.

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.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Stop warfarin about 5 days before and confirm INR is 1.5 or less before surgery. Warfarin has a long effect, so it is stopped about 5 days before major elective surgery, and the INR is checked to be at or below about 1.

Why is "Continue warfarin and give protamine on the morning of surgery" not the answer?

Protamine reverses heparin and does not reverse warfarin.

Why is "Stop warfarin the evening before surgery" not the answer?

One day is too short for the INR to normalise.

Why is "Give platelet transfusion before incision" not the answer?

Warfarin does not reduce platelet count, and platelets do not reverse it.

What concept does this question test?

It tests Perioperative: anticoagulant management in General Surgery. 5 before surgery. Bridging with heparin is reserved for those at the highest thrombotic risk, such as a mechanical mitral valve or recent stroke. Urgent surgery is managed with vitamin K or prothrombin complex concentrate.

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 Perioperative: anticoagulant management?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.