62 year old with a prosthetic mitral valve was noted to have the following coagulation profile
|
Test |
Value |
Normal range |
|
PT |
101 sec |
(12-14) |
|
APTT |
45 sec |
(34-38) |
|
INR |
8.7 |
(0.8-1.2) |
a) What is the likely diagnosis?
b) Outline your management of this patient
College Answer
a) What is the likely diagnosis?
Supratherapeutic warfarinisation
b) Outline your management of this patient
If Non-bleeding
Stop warfarin
Vit K low dose iv or oral
Consider FFP if patient has a high risk of bleeding
If bleeding
Resuscitation stop warfarin
vit K low dose as possible
clotting factor FFP 10 to 15 ml per KG
consider prothrombinex (20 to 25 IU/KG especially if fluid is a problem
Discussion
This question closely resembles Question 15.1 from the second paper of 2011.
References
Hunt, Beverley J. "Bleeding and coagulopathies in critical care." New England Journal of Medicine 370.9 (2014): 847-859.