If a patient's INR is between 3.5 and 5 without major bleeding, what is the recommended management?

When a patient's International Normalized Ratio (INR) is between 3.5 and 5 without the presence of major bleeding, the recommended management involves adjusting the anticoagulation therapy. Specifically, lowering the dose or omitting a dose of the anticoagulant is appropriate in this scenario. The rationale behind this approach is to mitigate the risk of developing a bleeding complication while still allowing the anticoagulation to remain effective for its intended purpose, such as preventing thromboembolism.

Administering 10 mg of vitamin K is typically reserved for situations where the INR exceeds 5 or when there is a concern for bleeding, as it can lead to a more rapid reversal of anticoagulation. Holding anticoagulation indefinitely is also not appropriate, as it could expose the patient to the risk of thrombosis. Starting fresh frozen plasma is indicated only in cases of significant bleeding or when rapid reversal is necessary, which is not the case when INR is elevated but without symptoms.

Therefore, the best course of action is to lower the dose of the anticoagulant or omit the next dose, allowing the INR to decrease naturally while maintaining some level of anticoagulation to prevent thromboembolic events.