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Hemarthrosis secondary to anticoagulant therapy is a well-known clinical problem. The pathologic process usually occurs in large joints and is reversible with the discontinuation of the anticoagulant medication. The condition presented for consideration here is unusual for two reasons. First, it is relatively uncommon for the ankle joint to be involved. Second, the destructive arthritis progressed after the medication was discontinued. Resting the involved joint until symptoms subside is often adequate treatment for anticoagulant-induced hemarthrosis. In an 84-year-old man, an arthrodesis was necessary to achieve a symptom-free ankle joint. Hemarthrosis secondary to anticoagulant medication may not be a benign disease process.