A 70-year-old man presents unconscious to the Accident and Emergency Department. He had been found by the warden at his sheltered accommodation, who brought in his medications: warfarin, furosemide and amoxycillin (10-day course, 5 days used). Examination showed a Glasgow coma scale of 5/15, a dilated left-sided pupil and right-sided upper motor neurone signs in the upper and lower limbs. A computed tomography scan of the brain shows a large left-sided subdural haematoma. Ten mg intravenous vitamin K was given immediately.
Blood tests are shown below:
haemoglobin (HB) 9.5 g/dl
white cell count (WCC) 5.3 x 109/l
platelets 403 x 109/l
activated partial thromboplastin time (APTT) 43 s (30–40s)
international normalized ratio 7.0 (target INR 2.5)
What is the best management for his acquired bleeding tendency?
1)Prothrombin complex concentrate 50 U/kg
2)Fresh frozen plasma 15 ml/kg stat
3)Factor VIII bypassing agent (FEIBA)
4)Ten units of cryoprecipitate
5)Fifty U/kg of recombinant activated factor VII