{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:31:21Z","timestamp":1780320681259,"version":"3.54.1"},"reference-count":38,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Thrombosis remains a leading preventable cause of global morbidity and mortality, with conditions like venous thromboembolism and atrial fibrillation affecting millions worldwide. Traditional anticoagulants (heparins, vitamin K antagonists) require careful monitoring due to narrow therapeutic windows. Direct oral anticoagulants (DOACs) greatly improved convenience and reduced certain hemorrhagic complications (notably intracranial hemorrhage) compared to warfarin, but bleeding, drug\u2013drug interactions, and unmet needs in special populations persist. This review highlights emerging strategies to decouple antithrombotic efficacy from bleeding risk. Novel agents targeting factor XI or XII (small molecules, antibodies, antisense oligonucleotides) have shown in early trials robust thromboembolism prevention with low bleeding. Advances in pharmacogenomics, biomarker-guided dosing, artificial intelligence risk prediction, and digital monitoring promise to personalize therapy. We discuss optimized approaches for high-risk subgroups (cancer-associated thrombosis, extremes of body weight, renal\/hepatic dysfunction, pregnancy, perioperative care, and COVID-19) with citations to current evidence. Finally, we outline critical systems-level considerations, including drug accessibility, cost-effectiveness, and educational strategies, that are necessary to realize precision anticoagulation. Our synthesis is grounded in recent peer-reviewed literature and emphasizes innovations likely to improve safety and efficacy of thromboprophylaxis.<\/jats:p>","DOI":"10.3390\/jpm15100490","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T07:17:52Z","timestamp":1760512672000},"page":"490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Next-Generation Anticoagulants: Precision Strategies for Patient-Centered Thromboprophylaxis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9401-810X","authenticated-orcid":false,"given":"Abdulrahman","family":"Nasiri","sequence":"first","affiliation":[{"name":"College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11623 Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology Center, King Salman Specialist Hospital, 55741 Hail, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawan","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Security Forces Hospitals Program, General Directorate of Medical Services, Ministry of Interior, 11481 Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Alshaer","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eysa","family":"Alsolamy","sequence":"additional","affiliation":[{"name":"College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11623 Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamad","family":"Alghethber","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Security Forces Hospitals Program, General Directorate of Medical Services, Ministry of Interior, 11481 Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"Alkharras","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Security Forces Hospitals Program, General Directorate of Medical Services, Ministry of Interior, 11481 Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2025, August 06). 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