Question

A 72-year-old man with atrial fibrillation on warfarin presents with an INR of 6.5 following antibiotic therapy. He has no active bleeding. What is the most appropriate management?

Accepted Answer

Cease warfarin and give oral vitamin K 1-2 mg

Answer

Continue current warfarin dose and recheck in a week

Answer

Administer prothrombin complex concentrate and IV vitamin K

Answer

Immediately switch to a DOAC at full dose

Answer

Ignore the INR as he is asymptomatic

Practice question

A 72-year-old man with atrial fibrillation on warfarin presents with an INR of 6.5 following antibiotic therapy. He has no active bleeding. What is the most appropriate management?