please answer - ihs2009

[ArchivalUser]

answer is A
coz he is at risk of PE again since he had a episode already. So discontinue warfarin.
But as we are not actively reversing his INR by giving vit K since he is not actively bleeding.

Admitting him to monitor if his INR normalizes without intervention (i.e Vit k ) and be watchful to prevent an episode of PE since he may have one again as we are discontinuing warfarin.

why not B - risk of another episode in the mean time till he returns.

[ArchivalUser]

why is he going to have anther PE if the INR is 7.3,

[ArchivalUser]

I can understand admitting if you need to monitor his INR everyday, but is the reason for admission because he is at risk for another PE???????

[ArchivalUser]

I mean to say if the inr drops below the therapeutic level in the mean time before he returns to hospital, If we are not monitoring him continously by not admitting him
he may have another episode then, not immediately when his inr is 7.3.

Hope I am clear.

[ArchivalUser]

good luck to u raj2006
and intemedus, fs3 meant tht while we have stopped his warfarin and told him to follow, he might not come again and might have another episode of PE, so its better to admit , stop warfarin, monitor his INR, do counselling and then discharge with the adjusted dose of warfarin

[ArchivalUser]

yes, of course , i didnt mean to question your knowledge,.. just thought discontinuing wafarin and everyday monitoring of INR would suffice,..

I thought the objective of this question was to get the message across that INR between 5 to 9 does not pose a serious risk of bleeding (according to guidelines)...

but again if you want the pt admitted for monitoring of INR, even that sounds logical to me,.. so i guess the answers must be a bit more elaborate- like admit and monitor ,

man! always these questions narrow down between two choices

[ArchivalUser]

and tht is the biggest problem, one gets stuck between 2 choices, u don't know wht is their key?
anyways good luck to everybody in match