 No-Ax are becoming more common among patients undergoing surgery, but there is limited guidance on how best to manage them during the perioperative period. This review provides recommendations for managing No-Ax in the perioperative setting, including when to stop taking them before surgery, when to perform neroxial procedures, and when to perform high-risk surgeries. It also discusses the use of specific reversal agents and prothrumbin complex concentrates as alternatives. This article was authored by Kwong Sub Kim, Jung Wook Sung, Sarah So, and others.