What is the recommended action if the INR is greater than 10 but there is no bleeding present?

When the INR (International Normalized Ratio) is greater than 10 without any signs of bleeding, the best course of action is to administer a small dose of oral vitamin K (2.5 to 5 mg) and hold the warfarin. This approach is recommended because oral vitamin K effectively reduces the INR over the next couple of days while providing a margin of safety, as the risk of bleeding remains low at this point.

Holding warfarin helps prevent further increases in INR that could potentially lead to complications if not addressed. The oral route is chosen over IV administration mainly due to its efficacy in non-urgent scenarios where immediate reversal is not critical, and there's no active bleeding.

Using vitamin K in this manner helps to safely and gradually normalize the INR levels while minimizing the risk of warfarin-associated complications. This strategy is aligned with guidelines for managing elevated INR levels without bleeding, focusing on patient safety and monitoring.