A nurse is caring for a client who takes warfarin for atrial fibrillation. The client arrives with sudden severe headache rated 10/10, vomiting, and right-sided weakness. The INR drawn in triage is 4.8. Which medication should the nurse anticipate administering first?
- A.Fresh frozen plasma (FFP)
- B.Vitamin K 10 mg IV
- C.Protamine sulfate IV
- D.4-factor prothrombin complex concentrate (4F-PCC)
Show answer & rationale
Correct answer
D. 4-factor prothrombin complex concentrate (4F-PCC)
Rationale
D is correct: 4-factor PCC (e.g., Kcentra) provides rapid reversal of warfarin anticoagulation in the setting of life-threatening hemorrhage such as intracranial bleeding. It acts within minutes and is the first-line agent per current stroke and hemorrhage guidelines when immediate reversal is needed. A is incorrect: FFP also reverses warfarin but requires large volumes, takes longer to administer, and carries risks of volume overload and transfusion reactions. It is second-line behind 4F-PCC for urgent reversal. B is incorrect: IV Vitamin K takes 12-24 hours to restore clotting factor synthesis and is too slow for an acute hemorrhagic emergency, though it is given concurrently for sustained reversal. C is incorrect: Protamine sulfate reverses heparin (especially unfractionated heparin), not warfarin.
Key concepts