Hypoxemia and Respiratory Distress in a Newborn

You are the doctor on-call in neonatal intensive care unit. 

What Warfarin Can Cause!

 Laila is a 7 year old female known case of congenital  mitral valve stenosis who underwent valve replacement at age of 3 months and she is maintained on warfarin with monthly follow-up of her coagulation status. Her last INR was 5 three weeks ago so her dose of Warfarin was decreased by 15%.  She presented to ER with 2 days history of vomiting, frontal headache and somnolence. CT brain without contrast is shown below:

What's the most appropriate level of INR she could have now?

• 0.5
• 2
• 3.5
• 7

What's your most appropriate next step of management?

• Switch from Warfarin to Heparin
• Start vitamin K and fresh freozen plasma transfusion
• Transfuse with platelets
• Observation