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Canadian Pharmacist Qualifying Exam Practice · Question

A patient on warfarin therapy for atrial fibrillation presents with an INR of 5.5. They are asymptomatic and have no bleeding. What is the most appropriate action?

For an INR between 4.5-10 with no significant bleeding, holding 1-2 doses and a modest dose reduction is typically recommended. Oral vitamin K is usually reserv

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Question: A patient on warfarin therapy for atrial fibrillation presents with an INR of 5.5. They are asymptomatic and have no bleeding. What is the most appropriate action?

Answer options: ✅ Hold 1-2 doses of warfarin and decrease the maintenance dose.

  • Administer oral vitamin K 2.5 mg and hold warfarin for 1 dose.
  • Administer intravenous vitamin K 5 mg.
  • Refer to emergency for fresh frozen plasma.

Correct answer: Hold 1-2 doses of warfarin and decrease the maintenance dose.

Explanation: For an INR between 4.5-10 with no significant bleeding, holding 1-2 doses and a modest dose reduction is typically recommended. Oral vitamin K is usually reserved for higher INRs or minor bleeding.

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