Purpose of Review <p>The number and complexity of minimally invasive pain procedures is rising and so is the number of patients undergoing these procedures who have cardiovascular comorbidities. A lot of these patients are on antithrombotic therapy. This review article evaluates management of anticoagulant therapy during interventional pain procedures.</p> Recent Findings <p>Multiple guidelines with revisions have been reported with management of anticoagulants when performing interventional pain procedures. There is lack of consensus amongst professional pain societies with certain anticoagulants and their bleeding risk. There have been case reports of adverse outcomes even when guidelines have been followed.</p> Summary <p>Guidelines from professional societies are helpful when managing anticoagulation in the setting of interventional pain procedures.The incidence of procedural complications is influenced by each patient's unique anatomical challenges, medical comorbidities, and the technical complexity of the procedure. Pain physicians should engage in shared decision-making with the prescriber, carefully balancing the risks and benefits of the procedure.</p>