General measures

Stop the anticoagulant drug

Document the timing and amount of the last drug dose and presence of pre-existing renal or hepatic impairment

Estimate the half-life and length of functional defect induced by the drug

Assess the source of bleeding

Request full blood count, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen concentration, creatinine concentration

If available, request a specific laboratory test to measure the antithrombotic effect of the drug

Correct haemodynamic compromise with intravenous fluids and red cell transfusion

Apply mechanical pressure, if possible

Use endoscopic, radiological or surgical measures to achieve haemostasis