03-23-2008, 06:01 PM
A 38-year-old man is receiving warfarin therapy for treatment of a deep venous thrombosis of the left leg that he developed 3 weeks ago. He comes for his scheduled prothrombin time INR determination. He denies gingival bleeding, hematuria, nosebleeds, or gastrointestinal disorders but reports a sore throat and fever that started about 1 week ago. He has not been able to swallow and has consequently been on a mostly clear liquid diet for the last week.
On physical examination, his temperature is 38.0 °C (100.4 °F). His posterior pharynx is erythematous but without exudate. There are several scattered ecchymoses on the forearms and legs. The remainder of the examination is normal.
The laboratory evaluation reveals a hematocrit of 41%; activated partial thromboplastin time of 37 s; and a prothrombin time INR of 6.0.
Which of the following is most appropriate for initial management of this patient™s elevated INR?
( A ) Transfuse two to four units of fresh frozen plasma
( B ) Stop warfarin; give vitamin K, orally
( C ) Stop warfarin; give vitamin K, intravenously
( D ) Stop warfarin; give vitamin K, intramuscularly
( E ) Stop warfarin
On physical examination, his temperature is 38.0 °C (100.4 °F). His posterior pharynx is erythematous but without exudate. There are several scattered ecchymoses on the forearms and legs. The remainder of the examination is normal.
The laboratory evaluation reveals a hematocrit of 41%; activated partial thromboplastin time of 37 s; and a prothrombin time INR of 6.0.
Which of the following is most appropriate for initial management of this patient™s elevated INR?
( A ) Transfuse two to four units of fresh frozen plasma
( B ) Stop warfarin; give vitamin K, orally
( C ) Stop warfarin; give vitamin K, intravenously
( D ) Stop warfarin; give vitamin K, intramuscularly
( E ) Stop warfarin