A general practitioner calls about a 54-year-old male with an INR of 7.3. He has been on 6 mg of warfarin daily for 3 years. He was commenced on the warfarin following a mechanical mitral valve replacement for acute infective endocarditis. His INR is usually kept between 2.5 and 3.5. He is feeling well and has no cutaneous bleeding, haematemesis, haematuria or bruising. He says that he has been taking antibiotics for the last 2 weeks that another doctor prescribed him for a chest infection.
A 37-year-old male presents 5 hours after ingesting 150 mg of warfarin. He is usually on 8 mg of warfarin daily for a mechanical aortic valve replacement (bicuspid) 10 years previously. He is asymptomatic and has an INR of 2.7. He is admitted overnight after a single dose of activated charcoal. His INR at midday the next day is 5.2.
Outline your management plan for this patient including frequency of INR and the use and dose of vitamin K.
A 47-year-old male presents to the emergency department with a large right haemothorax, haematuria and widespread bruising. He has an INR >15 and a haemoglobin of 70. He has been repeatedly ingesting concentrated liquid rodenticide over the last week.
A 2-year-old boy is brought in by his parents after eating some pellets from a box of rat killer. He was playing in the backyard and found the box of rat killer. He said he ate some pellets and it is estimated at about 5 pellets. He is brought to the emergency department within an hour of exposure. He is alert and well. There is nothing to find on examination. His INR is 1.1.