Question

A patient is admitted with history of overdose of warfarin. Prothrombin time is significantly prolonged and the patient has ecchymosis and haematemesis. Therapeutic choices should include 1. Vitamin K 2. Naloxone 3. Fresh frozen plasma 4. N-acetylcysteine. Select the correct answer using the codes given below: Codes:

• A. 1 only
• B. 1 and 3
• C. 2 and 4
• D. 1, 2 and 3

Hint:

Eliminate the two drugs that treat completely unrelated poisonings first.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
A patient with warfarin overdose has a markedly prolonged prothrombin time and is actively bleeding, shown by bruising (ecchymosis) and vomiting blood (haematemesis). The question asks which of four listed measures are appropriate treatment.

Step 2: Key Concept or Approach:
Warfarin blocks the vitamin K-dependent clotting factors II, VII, IX, and X. Reversing its effect in a bleeding patient needs two things together: replacing vitamin K so the liver can resume making functional clotting factors, and giving fresh frozen plasma to supply those clotting factors immediately, since vitamin K alone takes hours to work.

Step 3: Working Through the Options:
Vitamin K is essential, it restores the liver's ability to produce active clotting factors and corrects the underlying cause of the prolonged prothrombin time. Fresh frozen plasma is equally essential in active, severe bleeding, because it contains the clotting factors themselves and works immediately, bridging the gap until vitamin K takes effect. Naloxone reverses opioid overdose and has no role in a bleeding disorder from warfarin. N-acetylcysteine is the antidote for paracetamol (acetaminophen) overdose and does nothing for anticoagulant-related bleeding. So the correct combination is vitamin K together with fresh frozen plasma, which is option 2 (1 and 3). Option 1 alone is incomplete because it leaves out the immediate factor replacement needed for active bleeding. Option 3 pairs two irrelevant drugs. Option 4 wrongly drags in naloxone, which has no place here.

Step 4: Conclusion:
The correct answer is 1 and 3, vitamin K and fresh frozen plasma.