Hemorrhagic complications from anticoagulants are very common. Their occurrence in a critical site such as the upper airways constitutes a vital emergency. Management must ensure antagonization of the anticoagulant effect and freedom of the upper airways. We will illustrate this through a clinical case with all the clinical signs that can alert a hematoma of the upper airways, the reversion strategies of old and new anticaogulants and respiratory management. We recommend admitting the patient to an intensive care unit, withholding anticoagulants and administering vitamin K and prothrombin complex concentrate as a means of reversing AVK. For direct oral anticoagulants, their cessation may be sufficient, otherwise non-specific reversion means are used, given the unavailability of antidotes apart from Idarucizumab for Dabigatran. For respiratory management we recommend a conservative attitude and in case of deterioration of the respiratory function a nasotracheal intubation under endoscopic guidance by an experienced doctor should be done. The resumption of anticoagulants must be decided according to the benefit risk ratio while involving the patient too and also taking into consideration the possibility of changing anticoagulants.