Bleeding is the most common complication of all anticoagulants. Any bleeding 
patient on an anticoagulant should be risk-stratified based on hemodynamic 
instability, source of bleeding, and degree of blood loss. Although minor bleed 
may be managed with discontinuation of anticoagulant, major bleed may require 
transfusion of blood products and use of specific antidote. The residual effects 
of each anticoagulant may be monitored with distinct coagulation assay. 
Intravenous or oral vitamin K can reverse the effect of warfarin within 24 to 48 
hours and is indicated for any bleeding, international normalized ratio of >10 
or 4.5 to 10 in patients with other risk factors for bleeding. Fresh frozen 
plasma or prothrombin complex concentrate (PCC) may be necessary in major 
bleeding related to warfarin. Protamine sulfate reverses the effect of 
unfractionated heparin completely and of low-molecular-weight heparin (LMWH) 
partially. Idarucizumab has recently been approved in United States for 
dabigatran reversal, whereas andexanet alfa is expected to get approved in the 
near future for reversal of oral factor Xa inhibitors. The PCC may reverse the 
effect of rivaroxaban to some extent, but no data are available regarding 
reversal of apixaban and edoxaban. Aripazine has shown promising results to 
reverse the effects of LMWH, fondaparinux, and direct oral anticoagulants but is 
still in the developmental phase.