New oral anticoagulants (NOACs ) have recently emerged as an alternative for vitamin K antagonists and are now widely available. Although there is good evidence for their roles in the appropriate clinical settings, so far no reversal agent is currently available. Likewise, there is no readily available laboratory test to quantify drug levels but coagulation assays may provide qualitative information about the presence of some NOACs . We aim to review the current literature regarding the optimal management of oral anticoagulation in the perioperative setting.