Coagulation disorders are common among critically ill patients. The critical care pharmacist plays an integral role in managing bleeding and clotting issues. Key aspects of managing coagulation in the intensive care unit (ICU) involve understanding coagulation monitoring tests, anticoagulant medications, managing anticoagulant reversal, handling device-related anticoagulation, addressing anticoagulation in the setting of procedures or surgery, and recognizing drug-induced thrombocytopenia. This chapter explores these coagulation topics in relation to clinical practice in critically ill patients and emphasizes the role of the critical care pharmacist or provider in this context.