A 72-year-old woman is being treated with warfarin for chronic atrial fibrillation. She presents to the emergency department with an active nosebleed that is not readily controlled and a markedly prolonged prothrombin time. What is the most appropriate therapy?

Question

Quizplus · Accepted Answer

The patient is likely experiencing an episode of over-anticoagulation from the warfarin, leading to a bleeding complication. Fresh frozen plasma contains clotting factors that can help reverse the effects of warfarin and should be given along with vitamin K to replenish the patient's clotting factors. Intravenous heparin would only further exacerbate the bleeding and tissue plasminogen activator is not indicated for this type of bleeding. Aspirin and cold compresses would not be effective in reversing the anticoagulation. DDAVP is used to increase production of von Willebrand factor, which is not the issue in this case.

A 72-Year-Old Woman Is Being Treated with Warfarin for Chronic