Prescribing information for all NOACs includes dose reduction criteria to avoid increased drug exposure (primarily due to impaired renal function). Concomitant administration of antiplatelet drugs and nonsteroidal antiin ammatory drugs should be avoided when possible as concomitant administration substantially increases bleeding risk. BP should be well controlled. General Supportive Measures: Given the short half-lives of these medications, minor bleeds may only require temporary discontinuation of anticoagulation for several doses. More signi cant bleeds may require additional supportive measures that include: local management (mechanical/surgical); volume resuscitation; and consideration of RBC and platelet transfusion, if In cases of overdose or in patients who took their last NOAC dose within 2 to 4 h, oral activated charcoal may attenuate absorption of drug.208-211 Laboratory Measurements: With respect to common coagulation tests, a prolonged aPTT indicates an anticoagulant effect of dabigatran, and a prolonged PT indicates an anticoagulant effect of the factor Xa However, the clinical utility of these common tests is limited due to the fact that a normal aPTT or PT does not exclude clinically relevant plasma levels of dabigatran and factor Xa inhibitors, respectively. The thrombin time (TT) is the most sensitive test for dabigatran; even low levels of dabigatran will prolong the TT so a normal TT excludes clinically relevant dabigatran concentrations. The dilute TT can be used to quantify dabigatran drug levels as it has good correlation across a wide range of dabigatran Chromogenic anti-factor Xa assays are recommended for rivaroxaban, apixaban, and edoxaban with calibration for the speci c agent.206 However, validation of these specialized coagulation tests is required, they are not universally available, and often have delayed turnaround time, which diminishes their usefulness in emergent situations. Asking patients when they took their last dose of NOAC is often the most practical method for quickly assessing residual anticoagulant activity. 