Considerable heterogeneity exists in the time cut-offs at which NOACs are to be withheld and restarted for elective surgery in patients with chronic kidney disease due to sparcity of objective data. The timing is dependent on the creatinine clearance (CrCl) and bleeding risk associated with the surgical procedure. The focus of this article is to highlight the discrepancies between multiple authors and to underscore the lack of precise time cut-offs in this clinical scenario. Prospective data from multi-centric registries is needed to eliminate the variability in the perioperative management of NOACs in the setting of renal compromise. Establishment of precise time cut-offs for different magnitudes of CrCls for holding and resumption of NOACs in the perioperative setting could eliminate ambiguity among clinicians.