QuestionSBA
QuestionChoice
This patient has an INR out of the target range and has experienced a minor bleeding episode. As the INR is between 5 and 8, IV vitamin K should be given. INR should then be rechecked and Warfarin restarted if INR is less than 5.
50206
a
Stop warfarin and give phytomenadione (vitamin K) by slow intravenous injection Restart warfarin when INR is less than 5
QuestionChoice
This patient has an INR out of the target range and has experienced a minor bleeding episode. Withholding 1-2 doses of Warfarin may be appropriate if this patient had an INR of 6.5 but no evidence of bleeding. As this patient has experienced some bleeding, treatment with vitamin K is recommended.
50208
c
Withhold 1 or 2 doses of warfarin and reduce subsequent maintenance dose
QuestionChoice
This patient has an INR out of the target range and has experienced a minor bleeding episode. Oral vitamin K should be given when INR is greater than 8 and there is no evidence of bleeding.
50207
b
Stop warfarin and give phytomenadione (vitamin K) orally
QuestionChoice
This patient has an INR out of the target range and has experienced a minor bleeding episode. As the INR is between 5 and 8, IV vitamin K should be given. INR should then be rechecked and Warfarin restarted if INR is less than 5.  Dried prothrombin complex concentrate or fresh frozen plasma would be appropriate where a severe bleeding episode has occurred.
50209
d
Stop warfarin, give urgent intravenous treatment with phytomenadione (vitamin K) and dried prothrombin complex concentrate (factors II, VII, IX, and X), or fresh frozen plasma if the dried prothrombin complex is unavailable
QuestionChoice
This patient has an INR out of the target range and has experienced a minor bleeding episode. As the INR is between 5 and 8, IV vitamin K should be given. If INR is consistently raised, a decrease in dose may be appropriate but is not the most important next step.
50210
e
Decrease Warfarin dose to 5mg
QuestionComment
he's not bleeding though so why would we not just withhold the warfarin for a couple doses like it says to in the bnf
42367
QuestionComment
exactly my thoughts, ButtMuncher.
61674
User
subscriber
Kawasaki Pudendal
User
subscriber
ButtMuncher
QuestionComment
He's stopped bleeding?
60844
User
subscriber
Patient Power
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3619
Warfarin and Vitamin K
Topic
9
Internal Medicine
10089
Case Presentation:  A 86-year-old female patient attends A&E with epistaxis, this has stopped within 30 minutes after nasal packing. She takes Warfarin for atrial fibrillation. 


**PMH**

* Atrial fibrillation
* Aortic Stenosis
* Psoriasis
* Psoriatic Arthritis

**DH**

* Warfarin 6mg OD
* Hydromol intensive cream QDS
* Paracetamol 1g QDS

**On Examination**

* HR 78bpm
* Blood pressure 124/80 mm/Hg
* Oxygen saturation 96%
* RR 16
* Temperature 36.8

**Investigations**

* INR: 6.5
* Target INR: 2-3

Question: Given the results of the above investigation, what is the most appropriate next step?
a