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In lesser numbers of canine AX cases, “large‐volume bleeding,” AFS 3 and 4 (modified AFS system ≥3), occurs (Lisciandro 2014a, 2016b). When detected, the challenge is again not to overreact because in our experience, dogs with PT and aPTT times that range no more than 25% over upper reference often do not need replacement of clotting factors as long as standard therapy, including glucocorticoids and histamine‐2 receptor blockers (second‐line medications), is used upfront (without delay) in patient management (see Table 7.7). AFS 3 and 4 (modified AFS system ≥3) cases are often confirmed as AX‐related heparin‐induced hemoabdomen because the free intraabdominal fluid is safely accessible for abdominocentesis and fluid characterization. These cases require close monitoring and coagulation profile(s). In cases with initial or serial coagulation profiles of >25% of upper reference range, clotting factors should be replaced. However, PCV, vital signs, physical exams, and repeating AFAST with AFS (or Global FAST) can help monitor (track) the patient, whether coagulopathic or not. See Table 7.7 for suggested management guidelines.