Activation of factor X initiates the common pathway in the clotting cascade, ultimately leading to fibrin clot formation. Direct oral anticoagulants (DOACs) exert their effects at this stage, with apixaban, edoxaban, and rivaroxaban directly inhibiting Factor Xa, while dabigatran acts on thrombin to prevent fibrinogen breakdown. DOACs have widely replaced warfarin in most non-valvular indications due to their ease of use, lower monitoring burden, fewer interactions, and comparable or improved safety profiles. Perioperative management of DOACs requires balancing bleeding and thrombosis risk, depending on patient and procedural risk factors. It is essential to understand how and when to stop or reverse the effects of DOACs in both the elective and emergency settings.