Prothrombinex-VF use for warfarin reversal should be restricted to emergency settings. Perioperative management of anticoagulant therapy requires an evaluation of the risk of thrombosis if warfarin is temporarily stopped, relative to the risk of bleeding if it is continued or modified. The British Society for Haematology is registered in England and Wales as a Company Limited by Guarantee, No 2645706 and as a Charity, No 1005735 Registered Office and correspondence address: 100 White Lion Street London N1 9PF. The BCSH guidelines on the Use of Fresh Frozen Plasma (FFP) recommend that FFP should not be used for warfarin reversal (British Journal of Haematology 2004; 126, 11-28). GUIDELINES FOR MANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION WITH ORAL ANTICOAGULANTS This guideline covers the management of patients being treated with Methods. A literature search was conducted utilizing Medline and the Cochrane Library, including papers published until May 3 rd 2012, with the objective of identifying original articles reporting on the use of PCC for warfarin reversal. Introduction. A BSH guideline on warfarin (Keeling et al, 2011) addressed the issue of perioperative management and is updated in this article to include the issue of perioperative management of patients on direct oral anticoagulants (DOACs) and antiplatelet agents, which are becoming frequent clinical queries. The British Society for Haematology is registered in England and Wales as a Company Limited by Guarantee, No 2645706 and as a Charity, No 1005735 Registered Office and correspondence address: 100 White Lion Street London N1 9PF. Reversal of warfarin with Vitamin K should be reserved only for the most serious bleeding events or patients who will not be restarted on warfarin. Vitamin K should be administered either orally or intravenously (IV) only. Warfarin is not usually indicated for ischaemic stroke without atrial fibrillation (except in antiphospholipid syndrome), retinal vessel occlusion, peripheral artery thrombosis, coronary artery graft or coronary angioplasty and stents. Recombinant activated FVII (rFVIIa) usage has been reported for warfarin reversal but all reports are retrospective, small series or without adequate controls. Although rFVIIa rapidly corrects the INR, its impact on stopping bleeding is unclear and its use cannot be recommended for warfarin reversal ( Rosovsky & Crowther, 2008 ; Skolnick et al , 2010 ).