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
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
This question closely resembles Question 15.1 from the second paper of 2011.
Hunt, Beverley J. "Bleeding and coagulopathies in critical care." New England Journal of Medicine 370.9 (2014): 847-859.