Preoperative assessment: anticoagulants: 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 · Preoperative assessment: anticoagulants

Sample item

A patient on warfarin for atrial fibrillation is scheduled for elective cholecystectomy. What is the usual plan?

AContinue warfarin and operate at INR of 3BGive protamine on the morning of surgeryCStop warfarin the night before surgeryDStop warfarin about 5 days before and operate when INR is below 1.5

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

The answer and the reasoning

D. Stop warfarin about 5 days before and operate when INR is below 1.5

Warfarin is stopped around 5 days before elective surgery so that the INR falls to under 1.5, with bridging heparin only for high thrombotic risk. Neuraxial block also needs a normal INR.

Option by option

A. Continue warfarin and operate at INR of 3
An INR of 3 means a high bleeding risk for major surgery.
B. Give protamine on the morning of surgery
Protamine reverses heparin, not warfarin.
C. Stop warfarin the night before surgery
Stopping the night before leaves the INR still raised.
D. Stop warfarin about 5 days before and operate when INR is below 1.5 (correct)
Correct. Stopping 5 days before allows INR to fall below 1.5.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Stop warfarin about 5 days before and operate when INR is below 1.5. Warfarin is stopped around 5 days before elective surgery so that the INR falls to under 1.

Why is "Continue warfarin and operate at INR of 3" not the answer?

An INR of 3 means a high bleeding risk for major surgery.

Why is "Give protamine on the morning of surgery" not the answer?

Protamine reverses heparin, not warfarin.

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

Stopping the night before leaves the INR still raised.

What concept does this question test?

It tests Preoperative assessment: anticoagulants in Anaesthesia. 5, with bridging heparin only for high thrombotic risk. Neuraxial block also needs a normal INR.

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 Preoperative assessment: anticoagulants?

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.