There is insufficient data on the use of NOACs during bleeding procedures in the dental office versus old oral anticoagulants. The current therapeutic indications are mostly based on the pharmacodynamics or on small cohort studies. Data from the literature has been reviewed in this respect. A 62-year-old patient under treatment with Rivaroxaban complained of transitory pain in the posterior upper-right jaw. The extraction of second upper right molar was performed, followed by the suture of the socket. According to the therapeutic indications and the available literature on the subject, the administration of the anticoagulant was not ceased. In the following days, repeated bleeding episodes were reported in direct correlation with the timing of Rivaroxaban administration and dose reduction was required to stop post-operative bleeding.Thus, the effect of NOACs could be unpredictable, as shown in the present case report. Therefore, further clinical research on the subject is needed.