q..........WARFARIN - lukes

[ArchivalUser]

A 49-year-old man comes to clinic for follow up and monitoring of his oral anticoagulation levels. The patient is postoperative day 62 from a left total knee replacement. On postoperative day number 2 he suffered a pulmonary embolism. He was placed on intravenous unfractionated heparin and then oral warfarin. He was discharged home with follow-up instructions to return to the clinic for monitoring of his prothrombin time/international normalized ratio (INR) every 3 weeks. On return to the clinic today his PT/INR is found to be 22.4/7.3. His physical examination is unremarkable. The most appropriate management at this time is to

A. admit the patient to the hospital
B. instruct the patient to discontinue warfarin and return in 1 week
C. instruct the patient to discontinue warfarin week until his next visit in 3 weeks
D. give protamine sulfate, intravenously
E. give vitamin K and follow up with the patient at his next visit

[ArchivalUser]

E
warfarin toxicity
INR more than 3 but less than 5 just stop warfarin for 1 to 2 days
INR between 5 to 9 low dose 2.5mg Vit K oral
INR between 9 to 20 High dose 5mg Vit K oral
INR more 20 intravenous Vitamin K

What ever the INR is and there is active bleeding give Fresh frozen plasma

[ArchivalUser]

EE stop warfarin regardless of whether there is bleeding or there isn't + oral Vit. K