Major or life-threatening bleeding — large-volume GI bleeding, intracranial-bleed signs, or hemodynamic instability — activate EMS/transfer; hold the anticoagulant and prepare for reversal per order.

Post-fall head strike on anticoagulation with any new headache, vomiting, confusion, drowsiness, unequal pupils, or focal deficit — transfer (delayed intracranial bleed).

Markedly supratherapeutic INR with bleeding — hold, notify, and escalate/transfer per severity and the reversal order.

Thromboembolic signs if anticoagulation is subtherapeutic/held (new stroke deficit, DVT/PE signs) — activate the appropriate pathway.