A patient on warfarin for atrial fibrillation presents with severe bruising and haematuria. What is the most appropriate course of action for the pharmacist to take?

• A. Reduce the dose and continue
• B. Stop the drug immediately
• C. Switch to heparin while continuing warfarin
• D. Do nothing

Answer: (B)

When anticoagulation is causing major bleeding, the priority is to stop the anticoagulant right away to limit further blood loss. Severe bruising and haematuria signal significant bleeding, so continuing or reducing but not stopping warfarin would not halt the bleed and could make things worse. Switching to heparin while still on warfarin would keep anticoagulation ongoing, which is not appropriate in the presence of active bleeding. Doing nothing would leave the patient at risk of life‑threatening hemorrhage.

The pharmacist should immediately discontinue warfarin and escalate for urgent medical management to reverse anticoagulation per local protocols (often intravenous vitamin K with a procoagulant such as PCC or FFP), plus urgent assessment of INR, hemoglobin, and bleeding source. Communicate with the treating clinician, ensure the patient receives appropriate reversal therapy, and provide safety guidance and arrange prompt follow‑up.