رجل عمره ٧٥ سنة يأخذ وارفارين لرجفان أذيني، وأخذ مضاداً حيوياً الأسبوع الماضي لالتهاب بولي. تحليله اليوم INR ٩٫٢، ولا يوجد أي نزيف ظاهر أو براز أسود، والعلامات الحيوية طبيعية. ما العلاج المتوقع عادة؟

A 75-year-old man on warfarin for atrial fibrillation took an antibiotic last week for a urinary infection. Today the INR is 9.2 with no visible bleeding or black stools, and vitals are normal. What treatment is usually expected?

1. Continue the same dose and recheck INR in a month
2. Give IV protamine sulphate
3. Give fresh frozen plasma to every such case immediately
4. Hold warfarin and give oral vitamin K as ordered

Answer: D) Hold warfarin and give oral vitamin K as ordered. An INR above 9 without bleeding is usually managed by holding warfarin, giving low-dose oral vitamin K and rechecking the INR. Protamine reverses heparin, and prothrombin complex or plasma is for serious bleeding.