Strategies for Perioperative Anticoagulant Reversal in Orthopedic Surgery: A Review.

IF 0.9 4区医学 Q3 SURGERY

Annali italiani di chirurgia Pub Date : 2024-01-01 DOI:10.62713/aic.3625

Yuanyuan Fang, Min He, Xiaoying Zhang

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引用次数: 0

Abstract

Aim: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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骨科手术围手术期抗凝药物逆转策略：综述。

目的：由于存在血栓事件和出血并发症的风险，骨科大手术期间的抗凝治疗是一项临床挑战。本综述旨在评估围手术期抗凝逆转的现有策略和新进展：我们对围术期抗凝治疗的管理进行了文献综述，其中包括抗凝逆转剂的现状，以及个性化医疗、药物基因组学、人工智能（AI）和新型给药系统：综述表明，伊达珠单抗和安达赛酮α等逆转剂对于控制直接口服抗凝剂（DOACs）引起的出血至关重要。在药物基因组学的指导下，个性化医疗可实现量身定制的抗凝方案。人工智能和机器学习（ML）算法可提高出血和血栓风险的预测能力。此外，纳米技术和生物标记为给药和个性化治疗提供了创新方法：将循证指南与创新逆转剂、个性化医疗、人工智能和纳米技术相结合，开创了围手术期抗凝管理的新时代。这些进步可以确保患者安全，最大限度地降低出血风险，改善手术效果。未来的研究应侧重于这些策略的临床验证，以确保它们在不同患者群体中的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annali italiani di chirurgia 医学-外科

CiteScore

0.90

自引率

12.50%

发文量

116

审稿时长

>12 weeks

期刊介绍： Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.