Dr Goldhaber assumes for the purposes of this debate that “we are defining coagulopathies as abnormal laboratory tests that point to susceptibility to bleeding … not clotting,”1 and I made the same assumption in my “pro” argument. Thus, Dr Goldhaber’s point that one must be certain that a given derangement represents a predisposition to bleeding rather than clotting (for example heparin-induced thrombocytopenia) are extremely important. Along these same lines, I agree that the risk-to-benefit ratio of reversing a coagulopathy for each patient must be considered. That is, is the risk of a potential prothrombotic state from reversing a coagulopathy greater than the risk of a life-threatening bleeding event during central line insertion? Dr Goldhaber cites the examples of patients with acute coronary syndromes or pulmonary emboli that might not tolerate a noncoagulopathic state due to risk of propagation of thrombosis, and these examples highlight that bedside decisions are critically dependent on the situation for each individual patient. Similarly, the risk-to-benefit ratio of waiting to correct a coagulopathy and which products might be selected to use in reversing a coagulopathy3,4 must be weighed against the urgency/emergency of central line insertion for each patient. If there is uncertainty as to what the nature of the coagulopathic derangement is in the setting of abnormal platelet counts or prothrombin time/partial thromboplastin time values, or if it is uncertain whether it would be safe to reverse a potential coagulopathic state, then consultation with an expert in this field, such as Dr Goldhaber, is certainly warranted.