The annual risk of major bleeding during vitamin K antagonists (VKAs) treatment is 1–2%, even if it is higher among patients without adequate management. Risk factors for bleeding are advanced age, tendency to fall, frailty, comorbidities, and poor anticoagulation. The management of bleeding during VKA treatment is related to the severity and the site of bleeding, requiring (1) prompt hemodynamic support; (2) international normalized ratio (INR) determination; and (3) treat and/or removal of the cause of bleeding. Vitamin K supplementation is required to allow the synthesis of coagulation factors, leading to INR normalization within 12–24 hours. In the case of life-threatening bleeding, rapid anticoagulation reversal is required, and prothrombin complex concentrates should be infused at the dosage of 20–50 mg/Kg. When clinically relevant nonmajor bleeding occurs, check INR to exclude overanticoagulation and obtain prompt INR normalization, withholding one or two doses of warfarin and administering vitamin K if INR is >6.0. When a minor bleeding occurs, usually anticoagulant treatment should not be stopped; however, INR checking is suggested to prevent more serious complications.