C is the correct answer. Why?

Explanation

Bleeding is one of the most common complications seen in patients with left ventricular assist devices (LVADs), most commonly from the gastrointestinal tract. The etiology is multifactorial, including anticoagulation use, the development of arteriovenous malformations secondary to low pulsatile flow, and shear force related to the device itself, whichcan cause hemolysis. In this hemodynamically stable patient taking warfarin with bleeding, an appropriate management strategy would be to hold subsequent warfarin doses and admit the patient to the hospital for further evaluation of his GI bleeding. In patients with serious bleeding or hemodynamic instability, warfarin should be held, vitamin K should be administered, and rapid reversal should be pursued with prothrombin complex concentrate or fresh frozen plasma, depending on availability. Resuscitation in hemorrhagic shock should be with a 1:1:1 ratio of platelets to red blood cells to fresh frozen plasma. The decision to resume anticoagulation should be made based on the patient’s underlying thromboembolic risk balanced with their risk of bleeding.

If this patient had hemodynamic instability (e.g., hypotension, altered mental status), then reversal of his anticoagulation with the administration of fresh frozen plasma (A) or vitamin K (B) would be an appropriate component of resuscitation. In a similar circumstance of hemodynamic instability, transfusion with 1 unit of packed red blood cells (D) or whole blood (E) would aid in the resuscitation to improve end-organ perfusion in a patient with hemorrhagic shock.