For reversal of anticoagulation in retroperitoneal hemorrhage, which treatment is indicated?

• A. Vitamin K and fresh frozen plasma
• B. Platelet transfusion
• C. Desmopressin
• D. Packed red blood cells alone

Answer: (A)

Reversing warfarin rapidly in a patient with a major bleed requires both stopping the drug’s effect and supplying the missing clotting factors. Administering vitamin K helps the liver resume production of vitamin K–dependent factors (II, VII, IX, X), but its effect takes several hours. Fresh frozen plasma provides those clotting factors immediately, giving prompt hemostasis and stabilizing the patient while the vitamin K takes effect.

Other options don’t address the reversal of anticoagulation. Platelet transfusion helps if there’s a platelet problem, not warfarin reversal. Desmopressin is used for certain platelet function disorders, not for reversing anticoagulation. Packed red blood cells alone improve oxygen-carrying capacity but don’t correct the coagulopathy.