An old lady came with complaint of pain in left calf region. A diagnosis of deep vein thrombosis (DVT) was made and she was put on warfarin therapy. After 3 months, she was brought to hospital with complaint of nose bleed which automatically stopped in few minutes. Her lab repos show INR of 7.0. To avoid hemorrhage, what to do next in addition to discontinuation of the drug?

**Core Concept**
Warfarin, a vitamin K antagonist, is used to prevent thrombosis by inhibiting the production of vitamin K-dependent clotting factors in the liver. The International Normalized Ratio (INR) is a measure of the time it takes for blood to clot, which is used to monitor warfarin therapy.

**Why the Correct Answer is Right**
The patient's INR is elevated at 7.0, indicating excessive anticoagulation. To avoid hemorrhage, vitamin K should be administered to reverse the effects of warfarin. Vitamin K works by replenishing the body's stores of vitamin K-dependent clotting factors, thereby reducing the INR and preventing further bleeding.

**Why Each Wrong Option is Incorrect**
**Option A:** Administering fresh frozen plasma (FFP) may be considered in cases of severe bleeding or when rapid reversal of anticoagulation is needed. However, it is not the first-line treatment for preventing hemorrhage in this scenario.

**Option B:** Discontinuation of warfarin is a necessary step, but it may not be sufficient to prevent hemorrhage, as the effects of warfarin may persist for several days after discontinuation.

**Option C:** Monitoring the patient's INR closely is essential, but it does not address the need to reverse the effects of warfarin and prevent hemorrhage.

**Clinical Pearl / High-Yield Fact**
In cases of warfarin-induced bleeding, vitamin K administration is the most effective way to reverse anticoagulation and prevent further bleeding. The dose of vitamin K should be guided by the patient's INR and clinical status.

**Correct Answer:** D. Administer vitamin K.

✓ Correct Answer: B. Vitamin K1