Managing Bleeding on OAC Bleeding on VKA: Management of active bleeding on a VKA depends on the severity (Fig 5).202 For all bleeding events, the site of bleeding should be assessed, with mechanical compression where appropriate, the time- point of the last dose of VKA should be obtained, with factors affecting bleeding risk documented (other medications, kidney function, alcohol abuse, other comorbidities) and hemodynamic status assessed (BP, pulse, etc). Assessment of INR, prothrombin time (PT), and activated partial thromboplastin time (aPTT) is essential; other laboratory tests should include renal function, hemoglobin, hematocrit, and platelet count. For minor bleeding, VKA administration should be withheld until INR < 2.0. Management of moderate bleeding requires prompt identi cation and intervention to treat the cause and may also necessitate uid replacement and/or blood transfusion. Where bleeding is severe or life-threatening, immediate reversal of the anticoagulant effect is required and administration of IV vitamin K, fresh frozen plasma, and prothrombin complex concentrates (PCCs) should be considered to restore coagulation. PCCs are preferred over fresh-frozen plasma for reversal due to a higher concentration of clotting factors and less volume. Bleeding on NOAC (Fig 5): Many physicians and patients have been reluctant to embrace NOACs due to their perception that they are not able to effectively manage patients who present with bleeding, particularly without a speci c reversal agent or antidote.203 A helpful framework to consider when managing NOAC-related bleeding includes: (1) prevention of bleeding, (2) general principles and supportive measures, (3) nonspeci c hemostatic agents, and (4) NOAC-speci c reversal Minimize the Risk of Bleeding: Selecting the right dose of the NOAC is the most important step to minimize bleeding risk. Prescribing information for all NOACs includes dose reduction criteria to avoid increased drug exposure (primarily due to impaired renal function). 