A 76-year-old client on long-term warfarin (target INR 2.0–3… | MyMerci
Adverse Effects/Contraindications/InteractionsPA
Question
A 76-year-old client on long-term warfarin (target INR 2.0–3.0) calls the clinic with bleeding gums and a few small bruises. Today INR is 5.5 and the client is hemodynamically stable. The provider orders the following. Which order does the nurse expect to be most appropriate?
1Hold the next 1–2 doses of warfarin, give oral vitamin K (phytonadione) 1–2.5 mg as ordered, recheck INR in 24 hours, and reinforce bleeding precautions.✓ Correct answer
2Continue the current warfarin dose as ordered, recheck INR at the next routine visit in 4 weeks, and reassure the client that mild bruising is expected with anticoagulants.
3Administer 4-factor prothrombin complex concentrate (PCC) intravenously and give intravenous vitamin K 10 mg slowly, then reassess INR within 12 hours.
4Discontinue warfarin permanently, start aspirin 81 mg once daily, and schedule a follow-up appointment in 3 months for re-evaluation without further anticoagulation monitoring.
Explanation
Warfarin INR-based reversal — graded approach (CHEST guideline) Management of supratherapeutic INR depends on the INR value AND the presence/severity of bleeding: • INR therapeutic to 10, no bleeding: hold warfarin and give oral vitamin K 2.5–5 mg. • Any major or life-threatening bleeding (regardless of INR): hold warfarin, give 4-factor PCC (Kcentra) and slow IV vitamin K 5–10 mg; FFP if PCC unavailable.
This client has minor bleeding (gums, small bruises) and INR 5.5. Many institutions hold warfarin and administer low-dose oral vitamin K 1–2.5 mg when minor bleeding accompanies a moderate supratherapeutic INR; some experts hold doses without vitamin K for minor bleeding plus INR
In-depth explanation
Clinical reasoning summary Warfarin INR-based reversal — graded approach (CHEST guideline) Management of supratherapeutic INR depends on the INR value AND the presence/severity of bleeding: • INR therapeutic to 10, no bleeding: hold warfarin and give oral vitamin K 2.5–5 mg. • Any major or life-threatening bleeding (regardless of INR): hold warfarin, give 4-factor PCC (Kcentra) and slow IV vitamin K 5–10 mg; FFP if PCC unavailable.
This client has minor bleeding (gums, small bruises) and INR 5.5. Many institutions hold warfarin and administer low-dose oral vitamin K 1–2.5 mg when minor bleeding accompanies a moderate supratherapeutic INR; some experts hold doses without vitamin K for minor bleeding plus INR