This literature review examines the evolution, mechanisms, and clinical applications of anticoagulant therapies. It is focused on comparing traditional agents like warfarin and heparins with modern direct oral anticoagulants (DOACs). The review first explains the coagulation cascade and its physiological regulation. The pharmacology of anticoagulant drugs is also examined to explain how these drugs target different points in the coagulation process. The paper also describes the clinical indications of anticoagulation such as the prevention and treatment of thromboembolic events like deep vein thrombosis, pulmonary embolism, atrial fibrillation-related stroke, and acute coronary syndromes. Warfarin and unfractionated heparin (UFH) have historically been the foundation of anticoagulant therapy for decades, with warfarin being essential in certain contexts due to its efficacy. Heparins are effective but limited by risks like heparin-induced thrombocytopenia and administration challenges. The introduction of DOACs marked a significant advancement in anticoagulation, offering fixed dosing, fewer drug and food interactions, and reduced need for monitoring. DOACs have become the preferred treatment for most indications, including non-valvular atrial fibrillation, venous thromboembolism, and post-operative thromboprophylaxis. The future of anticoagulation lies in emerging therapies like Factor XI inhibitors and RNA- targeted agents, aiming to maintain efficacy while minimizing bleeding risk.