This review article discusses the precision use of anticoagulants to reduce adverse drug reactions. It highlights the importance of tailoring anticoagulant therapy to individual patient characteristics, including genetic, environmental, and clinical factors, to improve safety and efficacy. The article reviews the current evidence for using genetic biomarkers to inform dosing and monitoring decisions, particularly for warfarin and direct oral anticoagulants (DOACs). It also addresses the challenges and opportunities in advancing precision anticoagulation, such as the need for further research on the impact of body weight, hepatic and renal impairment, and elderly patients. The review emphasizes the importance of integrating genetic and environmental factors into algorithms to define distinct patient subgroups and develop optimal therapeutic strategies. Additionally, it discusses the role of monitoring and antidotes for DOACs and the complexities of anticoagulant therapy with parenteral anticoagulants like heparin. The article concludes by identifying areas that require further research to enhance the precision and safety of anticoagulation therapy.This review article discusses the precision use of anticoagulants to reduce adverse drug reactions. It highlights the importance of tailoring anticoagulant therapy to individual patient characteristics, including genetic, environmental, and clinical factors, to improve safety and efficacy. The article reviews the current evidence for using genetic biomarkers to inform dosing and monitoring decisions, particularly for warfarin and direct oral anticoagulants (DOACs). It also addresses the challenges and opportunities in advancing precision anticoagulation, such as the need for further research on the impact of body weight, hepatic and renal impairment, and elderly patients. The review emphasizes the importance of integrating genetic and environmental factors into algorithms to define distinct patient subgroups and develop optimal therapeutic strategies. Additionally, it discusses the role of monitoring and antidotes for DOACs and the complexities of anticoagulant therapy with parenteral anticoagulants like heparin. The article concludes by identifying areas that require further research to enhance the precision and safety of anticoagulation therapy.