What should be administered if the INR is between 4.5 and 10 with a high bleed risk while on warfarin?

When a patient's INR (International Normalized Ratio) falls between 4.5 and 10 and they are at a high risk for bleeding while on warfarin, the appropriate action is to administer oral vitamin K. This choice helps to reduce the INR back into a safer range without the need for more aggressive interventions that might have additional risks.

Oral vitamin K in a dose of 1-2.5 mg is typically sufficient to lower the INR effectively, allowing the body's natural clotting mechanisms to resume function while minimizing the risk of bleeding. This approach is favored in situations where the INR is elevated but not severely so, particularly when there is a concern for potential bleeding. Oral administration is less invasive and allows for the gradual correction of INR compared to other methods.

In contrast, administering larger doses of intravenous vitamin K or fresh frozen plasma would generally be reserved for more severe cases where INR is significantly higher, or there is urgent need for reversal of anticoagulation. These options carry greater risks and potential side effects, making them less suitable in a case involving an elevated INR that is not critically high.