Direct oral anticoagulants (DOAC) have changed the care of patients with an indication for long-term or permanent anticoagulation. In the most common indications for anticoagulation (non-valvular atrial fibrillation and treatment of venous thromboembolism) they represent the first-line therapy. Available DOAC include the factor IIa inhibitor dabigatran and the factor Xa inhibitors edoxaban, rivaroxaban, and apixaban. Due to expanded indications, the number of DOAC prescriptions is increas-ing, as is the incidence of DOAC-associated bleeding. Life-threatening bleeding under DOAC therapy most commonly manifests as gastrointestinal bleeding. In an emergency situation with critical bleeding, checking DOAC plasma con-centrations is often helpful. Conventional standard tests such as aPTT or Quick/INR are unsuitable for this purpose, which is why DOAC-specific tests such as diluted thrombin time (for factor-IIa-inhibitors) or anti-Xa assays (for factor-Xa-inhibitors) are used in clinical practice. DOAC-specific viscoelastic testing offers a time-saving alternative. If none of these measurements are available, urine test strips (DOAC dipstick) provide a means to exclude a relevant DOAC plasma concentration. In case of the need to reverse the effect of DOACs in the event of a critical bleed, coagulation factor preparations like prothrombin complex concentrates (PPSB) can be used. Another option includes specific antagonists such as idarucizumab (for antagonising dabigatran) and andexanet alfa (for antagonizing rivaroxaban, apixaban, and off-label edoxaban). The advantages and disadvantages of each treatment regime are the subject of current research. Thus, the reversal of DOAK in critically bleeding patients is an individual patient decision.