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pt on warfarin,inr-7,presents with ischemic infarct-

next step
take him off warfarin, give vit k. also heparin
its ischemic infarct not hemorrhagic...
may be bolus infusion of heparin and increase the dose of warfarin ( take out any medicine that is making warfarin less effective if possible )
how about angioplasty
and also add aggrenox to his meds