If a patient is on Warfarin and INR comes out to be 8. Next step would be to stop the drug and: March 2011
**Core Concept**
Warfarin is a vitamin K antagonist used as an anticoagulant. It inhibits the production of vitamin K-dependent clotting factors in the liver, leading to an increased International Normalized Ratio (INR) when monitored. An INR of 8 indicates a high risk of bleeding due to excessive anticoagulation.
**Why the Correct Answer is Right**
When a patient is on Warfarin and INR is 8, the next step is to reduce the anticoagulant effect. This is achieved by administering vitamin K, which helps to restore the production of vitamin K-dependent clotting factors. Vitamin K is given orally or intravenously, and its effect is usually seen within 6-24 hours. This allows the INR to decrease, thereby reducing the risk of bleeding.
**Why Each Wrong Option is Incorrect**
* **Option A:** Administering Fresh Frozen Plasma (FFP) would be incorrect as it would temporarily correct the coagulopathy but does not address the underlying issue of Warfarin's effect on vitamin K-dependent clotting factors.
* **Option B:** Discontinuing Warfarin without replacing it with another anticoagulant would leave the patient at risk of thromboembolic events.
* **Option C:** Increasing the dose of Warfarin would exacerbate the anticoagulant effect and increase the risk of bleeding.
**Clinical Pearl / High-Yield Fact**
When administering vitamin K to reverse Warfarin's effect, it is essential to note that the dose and route of administration may vary depending on the severity of the coagulopathy and the patient's overall clinical condition.
**Correct Answer: B. Discontinue Warfarin and administer Vitamin K.**