One way of thinking about perioperative medicine is to define it as 'comprehensive care of the procedural patient over the entire spectrum of perioperative time and space'. As any anesthesiologist can attest, all of perioperative time and space is a big chunk of medical practice. Within this huge mass of perioperative knowledge and skill, one of our main areas of focus is clinical pharmacology.In preparing this issue of the Journal, Dr Ken Johnson and I asked a number of experts to opine on clinical pharmacology topics of contemporary interest to perioperative medicine specialists. These pharmacology gurus take on broad and diverse topics, some of which deal with recent 'giant leaps' in anesthesia-related clinical pharmacology (e.g. sugammadex), and others of which are focused on incremental advances ('small steps'). All of these subjects are of interest to both clinicians in the trenches of everyday practice and also to investigators and educators who are working to advance the field.In this editorial, we provide a brief introduction to the reviews in this specially commissioned issue of the Journal, offering background and clinical context for their interpretation. We thank the authors for their excellent contributions and hope that our readers will find useful material that improves the care of their patients and elevates their research and education efforts.Levy and Mamoun [1] have taken on the topic of direct oral anticoagulants (DOACs) and their antagonists. This therapeutic area is rapidly changing, with numerous new drugs and applications appearing over the last decade. The importance of this therapeutic area is a function of the numerous patients treated with these drugs who present for both elective and emergency operations.The authors begin by summarizing the clinical pharmacology of the available DOACs, including both the Xa and direct thrombin inhibitors. A detailed review of the antagonists of the DOACs then sets the stage for a discussion of the perioperative management of patients who are anticoagulated with these drugs.