The recent years have witnessed an increased activity in biocompatibility research aimed at limiting biomaterial-induced blood coagulation. From 2008 to 2016, a total of $36,946,764.00 USD was awarded in grants to 213 research proposals and as large as 50.4% ($18,627,854.00) of that award monies were distributed to 101 proposals over the fiscal years of FY14 to FY16 alone. However, the complexity in blood responses to biomaterials, variability in blood function between individuals and animal species, and differences in medical device application and test setting all continue to pose difficulties in making a breakthrough in this field. This review focuses on the remaining challenges in the context of biomaterial surface interaction with blood, biomaterial properties and their influence on coagulation, old and new surface anticoagulation methods, main test systems (complement and platelet function) for evaluating those methods, limitations of modification techniques, and the current state of systemic anticoagulation usage as adjunctive therapy for controlling blood coagulation on biomaterials. Finally, we propose ingredients necessary for advancing the field towards achieving totally local surface anticoagulation on blood contacting devices including standardization of in vitro and in-vivo test methods. Some highlights of recent forwardlooking work and articles on local anticoagulation are also presented.