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With the advent of new oral anticoagulants (NOACs), it is a challenge for a plastic surgeon to stay updated with the myriad of new medications, and their associated mechanisms of action, laboratory monitoring, adverse events and potential reversal agents. The limitations of warfarin therapy include varying pharmacokinetic profiles, multitude of food and drug interactions, hypersensitivity, resistance, therapy failure and frequent laboratory monitoring)¹. Hence there are an increasing number of patients who are presenting to their plastic surgeon on alterative antithrombotic agents. The aim of this paper is to educate Plastic Surgeons regarding NOAC's, and their management in the operative setting.