What is the recommended treatment for an elevated INR with life-threatening bleeding?

In cases of life-threatening bleeding associated with an elevated INR, the most effective and immediate treatment involves both vitamin K and fresh frozen plasma (FFP). Fresh frozen plasma contains clotting factors that are crucial for hemostasis, which are often depleted if the INR is elevated due to anticoagulation therapy. Administering FFP provides these factors rapidly and helps to reverse the anticoagulation effects, thereby addressing the immediate risk of bleeding.

While vitamin K is important in the overall management of elevated INR levels, particularly for longer-term reversal, administering 10 mg of vitamin K intravenously in conjunction with FFP offers both immediate correction of coagulopathy through the replacement of clotting factors and promotes the synthesis of new clotting factors over time. This combination is critical in acute scenarios where rapid hemostatic improvement is needed.

Subcutaneous administration of vitamin K or oral vitamin K is ineffective for urgent reversal since these methods do not provide the immediate response necessary in life-threatening situations. Skipping the next dose of the anticoagulant would not adequately address the current bleeding and is not a sufficient intervention.