Which treatment is indicated for a patient on warfarin who presents with a major bleed?

When a patient on warfarin experiences a major bleed, the immediate treatment involves the reversal of warfarin's effects. Administering intravenous Vitamin K is a critical step in this management. The primary goal is to counteract the anticoagulant effects of warfarin quickly and effectively.

Giving 5 mg of intravenous Vitamin K is justified because it allows for faster correction of the coagulation status compared to oral Vitamin K or simply stopping warfarin without further intervention. Vitamin K acts by replenishing the levels of the clotting factors that have been inhibited by warfarin, thus aiding in the coagulation process and helping to control the bleeding.

In contrast, restarting warfarin immediately would pose a high risk of further bleeding, making it inappropriate in this situation. High-dose oral Vitamin K, while an option, is not the most immediate or effective method for addressing a major bleed as it takes longer to bring about the efficacy needed in acute settings. Monitoring alone until bleeding stops is also insufficient as it does not address the active anticoagulation effect of warfarin and can lead to continued hemorrhage.

In summary, the combination of stopping warfarin and providing intravenous Vitamin K represents the most judicious and effective approach to managing