The Real-World Boards: Question #35
Undoing warfarin takes some doing, sometimes
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An 81-year-old man arrives in the emergency department after experiencing dark stools for a week. He takes warfarin for a mechanical mitral valve, and also for atrial fibrillation and a history of massive pulmonary embolism treated with thrombolytics six months ago.
His blood pressure is 110/55; his pulse is 110/min. Hemoglobin is 6.3 g/dL. INR is 3.4.
Vitamin K and packed red blood cells are ordered. Both fresh frozen plasma and 4-factor prothrombin complex concentrate are available.
