A 35-year-old woman on warfarin for atrial fibrillation presents with recurrent bilateral epistaxis over 3 weeks. INR is 4.2 (therapeutic range 2–3). Anterior rhinoscopy reveals no visible bleeding point, but blood is oozing diffusely from both nasal cavities. Coagulation studies show PT 45 seconds, platelet count 250,000/μL, aPTT 38 seconds. What is the most appropriate immediate management?

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