Anticoagulation therapy management has evolved dramatically in both the outpatient and inpatient arenas over the last 30 years in the interest of optimizing patient safety and outcomes. With the advent of target specific oral anticoagulants and next generation antiplatelet agents, a new world of "antithrombosis management" is quickly becoming evident. Additionally, significant changes to the healthcare system in the United States are anticipated with the implementation of the Healthcare Affordability Act. Collectively, these changes constitute the next major evolution in the management of patients on antithrombotic therapy. This article is intended to serve as a call to action for inpatient anticoagulation management services and specialists to familiarize themselves with potential changes, consider the impact they may have and proactively optimize their structure and services to be better able to embrace and capitalize on change.