Heparins and coumarins have been ruling the anticoagulant class for the past 60 years, but the trend in the drug discovery, prominence of target-based approach, and high-throughput screening has brought newer molecules in the forefront. Newer oral anticoagulants (NOACs) with different therapeutic challenges have largely come up in the past 5 years and overcome the limitations of traditional anticoagulants. The debate for specific guidelines for their use has been on for years. Interventional pain physicians admonished that available guidelines for regional anesthesia in patients receiving anticoagulants were insufficient as pain procedures covered a far broader gamut reflecting diverse goals. Hence, experts from different groups and committees got together and summed up guidelines and stratified interventional pain procedures based separately on patient- and procedure-specific factors. Here, in this review, we discuss the NOACs and their impact on interventional pain procedures.