A 71-year-old woman with atrial fibrillation on warfarin presents with melena and dizziness. Vital signs show BP 92/58, HR 108, RR 20, temp 36.8°C, SpO2 98% on room air. Laboratory studies reveal INR 7.8, hemoglobin 7.2 g/dL (previously 12.1), and normal platelet count. She denies recent trauma or falls. She is actively bleeding from the gastrointestinal tract. Which of the following is the most appropriate immediate management?
- A)Hold warfarin and repeat INR tomorrow
- B)Administer vitamin K alone
- C)Administer idarucizumab
- D)Administer 4-factor prothrombin complex concentrate plus vitamin KGABARITO
- E)Administer protamine sulfate
Explicação
Life threatening warfarin associated bleeding requires rapid replacement of vitamin K dependent clotting factors with 4-factor prothrombin complex concentrate plus vitamin K for sustained reversal. Vitamin K alone works too slowly in active major bleeding. Ver explicação completa e trilha adaptativa →