The chapter provides information on changing landscape of oral anticoagulants with references to the last pieces of the puzzle. With the emergence of novel oral anticoagulants (NOACs) which are broadly classified as direct thrombin inhibitor such as Dabigatran and direct factor Xa inhibitors such as rivaroxaban, apixaban, and edoxaban. In the treatment of atrial fibrillation, pulmonary embolism and venous thromboembolism these drugs have equipped overcome the limitation posed by warfarin and allied drugs. Use of these NOACs is being encouraged but most of the NOACs drugs must be considered based on the patient’s characteristics and physician’s choice. However the question remains the cost of these newer medicines in India. Hence future research in this field of pharmacy in near future can lead to the greater use and lower price which can turn into stepping stone that will help us manage anticoagulation with great ease. The chapter also mentions on concomitant use of NOACs and digoxin, transition to oral vitamin k antagonists from novel oral anticoagulants, bleeding in patients receiving novel oral anticoagulants, acute coronary events and novel oral anticoagulants and renal impairment and novel oral anticoagulants.