We cardiologists deal daily with patients who have an apparent laboratory-diagnosed coagulopathy but who simultaneously require urgent or emergent cardiac catheterization to manage acute coronary syndrome (ie, unstable angina, non-ST-segment-elevation myocardial infarction, or ST-segment-elevation myocardial infarction). In these situations, we are mostly inserting central arterial lines rather than central venous lines. Our cardiac patients usually take aspirin for primary or secondary prevention of coronary artery disease. Some receive dual antiplatelet therapy, such as aspirin plus clopidogrel, because of prior episodes of acute coronary syndrome or because of prior placement of a drug-eluting coronary artery stent. Others take warfarin to prevent stroke from atrial fibrillation. Urgent or emergent cardiac catheterization might be necessary for a patient taking the dreaded “triple therapy” of aspirin, clopidogrel (or prasugrel or ticagrelor), and warfarin. To make matters worse, the two newer antiplatelet agents, prasugrel1 and ticagrelor,2 cause more bleeding complications than clopidogrel. At the time of the cardiac catheterization, we add heparin or bivalirudin to the patient’s previously established antiplatelet and/or anticoagulant regimen.