Department of Pharmacy, The First People's Hospital of Xiaoshan District, 311200 Hangzhou, Zhejiang, China.
Ann Ital Chir. 2024;95(5):788-800. doi: 10.62713/aic.3625.
The administration of anticoagulation therapy during major orthopedic surgeries is a clinical challenge due to the risk of thrombotic events and bleeding complications. This review aims to evaluate the current strategies and emerging developments in perioperative anticoagulation reversal.
We conducted a literature review on the management of perioperative anticoagulant therapy, which included the current status of anticoagulant reversal agents, as well as personalized medicine, pharmacogenomics, artificial intelligence (AI), and novel drug delivery systems.
The review indicates that reversal agents such as idarucizumab and andexanet alfa are crucial in managing bleeding associated with direct oral anticoagulants (DOACs). Personalized medicine, guided by pharmacogenomics, allows for tailored anticoagulation regimens. AI and machine learning (ML) algorithms can enhance the predictive capabilities for bleeding and thrombotic risks. Additionally, nanotechnology and biomarkers offer innovative approaches to drug delivery and personalized treatment.
Integrating evidence-based guidelines with innovative reversal agents, personalized medicine, AI and nanotechnology opens a new era in perioperative anticoagulation management. These advancements can ensure patient safety, minimize bleeding risks, and improve surgical outcomes. Future research should focus on the clinical validation of these strategies to ensure their effectiveness across diverse patient populations.
在大型骨科手术期间进行抗凝治疗是一项临床挑战，因为存在血栓形成事件和出血并发症的风险。本综述旨在评估围手术期抗凝逆转的当前策略和新进展。
我们对围手术期抗凝治疗管理进行了文献回顾，其中包括抗凝逆转剂的现状，以及个体化医学、药物基因组学、人工智能（AI）和新型药物输送系统。
综述表明，idarucizumab 和andexanet alfa 等逆转剂对于管理直接口服抗凝剂（DOACs）相关的出血至关重要。个体化医学通过药物基因组学指导，可以制定个体化的抗凝方案。AI 和机器学习（ML）算法可以增强对出血和血栓形成风险的预测能力。此外，纳米技术和生物标志物为药物输送和个体化治疗提供了创新方法。
将循证指南与创新的逆转剂、个体化医学、AI 和纳米技术相结合，为围手术期抗凝管理开辟了一个新时代。这些进展可以确保患者安全，最大限度地降低出血风险，并改善手术结果。未来的研究应侧重于这些策略的临床验证，以确保在不同患者群体中的有效性。
