{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:47:54Z","timestamp":1782362874438,"version":"3.54.5"},"reference-count":122,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anticoagulant therapy is indispensable for thromboembolism management, yet it presents an inherent pharmacological paradox by elevating the risk of catastrophic hemorrhage. Navigating this dynamic hemostatic equilibrium remains a profound clinical challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Pharmacological landscape<\/jats:title>\n                    <jats:p>This review systematically evaluates the evolution of procoagulant strategies. While specific reversal agents (e.g., idarucizumab, andexanet alfa) have inaugurated an era of targeted precision reversal through high-affinity molecular neutralization, their widespread application is frequently hampered by exorbitant pharmacoeconomic costs, limited accessibility, and latent prothrombotic \u201coff-target\u201d effects (e.g., TFPI inhibition). Conversely, non-specific agents, epitomized by four-factor prothrombin complex concentrate (4F-PCC) and adjunctive antifibrinolytics, retain a foundational, highly cost-effective role in real-world rescue paradigms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Technological innovations<\/jats:title>\n                    <jats:p>To circumvent existing limitations, current technological trajectories are pivoting towards the rational design of broad-spectrum synthetic molecules (e.g., ciraparantag) and highly programmable nucleic acid aptamer systems. These innovations promise to deliver \u201con-demand\u201d reversibility and democratize access to hemostatic therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical management &amp;amp; perspectives<\/jats:title>\n                    <jats:p>Translating these pharmacological breakthroughs into optimal patient outcomes necessitates a paradigm shift in clinical workflows. We propose a multidimensional framework driven by point-of-care (POC) viscoelastic testing, algorithmic clinical decision support systems, and sequential therapy pathways managed by multidisciplinary \u201cCode Bleed\u201d teams. Future research must urgently prioritize large-scale, head-to-head randomized trials focused on patient-centered hard endpoints, ultimately refining evidence-based strategies to maximize therapeutic efficacy while strictly mitigating thrombotic risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1846208","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:21:35Z","timestamp":1782361295000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From empirical hemostasis to precision reversal: clinical challenges, technological innovations, and individualized strategies in anticoagulant-associated bleeding"],"prefix":"10.3389","volume":"13","author":[{"given":"Wei","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Traditional Chinese Medicine, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunqiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]},{"name":"Department of Special War Wound, Daping Hospital, Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyang","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuiyao","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihui","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Second Affiliated Hospital of Army Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Second Affiliated Hospital of Army Medical University","place":["Chongqing, 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