answer

- The answer is A,B,C,E - With meticulous hemostatic technique, many operations can be performed on patients with an INR greater than 1.5. - Exceptions include operations on the eye or the prostate, neurosurgical procedures, or a blind needle aspiration. - In these cases, an INR of less than 1.2 is required. - Patients who are receiving anticoagulant treatment with warfarin and who require emergency surgery may be given plasma to immediately reverse reverse the warfarin effect. - Alternatively, vitamin K may be given orally or subcutaneously at least 6 hr preoperatively to reverse the effect of warfarin on vitamin K dependent factors. - The INR should be obtained again before surgery and, if it is not below 1.5, plasma should be administered. - The efficacy of recombinant activated factor VII (rFVIIa) in reversing the INR has been demonstrated in several clinical scenarios. - This medication has the advantage of directly activating the hemostatic mechanism and generating high concentrations of thrombin. - Use of rFVIIa should be reserved for patients with life-threatening hemorrhage and a significantly significantly elevated INR (>6) in whom emergency surgery is anticipated. - An INR greater than 1.5 is a contraindication to intramuscular medications.