For a patient with cirrhosis and acute bleeding needing INR reversal, what is the recommended approach?

In the context of a patient with cirrhosis experiencing acute bleeding and requiring INR reversal, the recommended approach involves administering Vitamin K. This is because Vitamin K is essential for the synthesis of clotting factors II, VII, IX, and X, which are often impaired in patients with liver dysfunction, such as those with cirrhosis.

In acute bleeding scenarios, particularly when an immediate effect is needed to enhance clotting, intravenous administration of Vitamin K is preferred. A dose of 10 units IV is appropriate as it provides a prompt response in circulating levels of Vitamin K-dependent clotting factors. This can be crucial for stabilizing the patient's condition and reducing the risk of further bleeding.

While other methods like fresh frozen plasma (FFP) may be effective for rapid INR reversal, they are often reserved for situations where the patient is critically unstable, or where there's a need for immediate replenishment of clotting factors and volume that Vitamin K alone cannot address.

Overall, administering Vitamin K in this manner is a critical and standard component of managing INR reversal in patients with hepatic impairment and ongoing bleeding, making it the recommended choice in this context.