OBJECTIVE: To review current status of clinical application and research progress of different anticoagulants in perioperative period of free flap transplantation. METHODS: A comprehensive review of recent relevant literature was conducted, focusing on clinical research concerning the application of anticoagulants in the perioperative period of free flap transplantation. The administration route, timing, dosage selection, effectiveness, and safety of commonly used and novel anticoagulants were summarized. RESULTS: At present, the anticoagulants mainly used in the perioperative period of free flap transplantation include drugs for venous thrombosis prophylaxis, drugs for arterial thrombosis prophylaxis, and physical/colloidal anticoagulants, etc. The administration strategies can be classified into two major categories: single-agent anticoagulation and combined anticoagulation. Single-agent anticoagulation mainly includes unfractionated heparin, low-molecular-weight heparin, aspirin, and novel anticoagulants. Combined anticoagulation is commonly a synergistic anticoagulation regimen dominated by heparin drugs, combined with aspirin, different antiplatelet drugs, and expansion agents. Studies indicate that perioperative anticoagulant administration can effectively reduce the risk of thrombosis in free flaps and improve the overall flap survival rate. However, significant differences exist in the impact of drug types, administration routes, initiation timing, and dosage intensity on efficacy and bleeding risk. A unified, standardized application protocol has not yet been established. In addition, there has been a growing number of studies on novel anticoagulant drugs. However, their superiority and optimal application strategies in the field of free flap transplantation still necessitate more high-quality evidence. CONCLUSION Perioperative anticoagulation therapy represents one of the key strategies for improving the survival rate of free flaps. However, there is still a lack of high-level evidence to establish a standard protocol. Future research should focus on the optimization of individualized anticoagulation strategies, the validation of the effectiveness of new anticoagulants, and the exploration of the advantages of different anticoagulation strategies. At the same time, attention should be paid to balancing anticoagulation and bleeding risks to promote the standardization of clinical practice and the improvement of treatment safety.
Humans ; Anticoagulants/therapeutic use* ; Free Tissue Flaps/blood supply* ; Thrombosis/prevention & control* ; Perioperative Care/methods* ; Heparin/therapeutic use* ; Heparin, Low-Molecular-Weight/administration & dosage* ; Perioperative Period ; Aspirin/therapeutic use*

Objective To analyze the application of outcome indicators and measurement tools in randomized controlled trials(RCTs)of TCM treatment for coronary heart disease(CHD)complicated with anxiety and depression in recent years;To facilitate the construction of core outcome set in this field.Methods The RCTs of TCM treatment for CHD complicated with anxiety and depression were retrieved from CNKI,Wanfang Data,VIP,CBM,PubMed,Web of Science,Embase,Cochrane Library,and the included RCTs were evaluated for bias risk,data extracted and analyzed.Results A total of 163 articles were included,with 157 outcome indicators categorized into 6 indicator domains according to their functional attributes.The application rates in descending order were symptoms and signs(98.16%),physiological and chemical tests(58.90%),TCM syndromes(48.47%),safety events(44.17%),quality of life(39.88%),and long-term prognosis(9.20%).By analyzing the frequency and distribution of outcome indicators,indicator combinations,measurement time points and tools found that the experimental design and the registration of study protocols were ignored,and the diagnosis and evaluation criteria of anxiety and depression and TCM diagnosis/syndrome differentiation were not standardized.The selection of outcome indicators was characterized by lack of comorbidity between CHD and anxiety and depression,no separation of primary and secondary,excessive number of indicators,irregular composite indicators,inconsistent application of TCM-specific indicators,lack of long-term prognosis,safety indicators and health economics evaluation.Conclusion There are some limitations in the RCT design and outcome indicators in the TCM treatment of CHD complicated with anxiety and depression.It is imperative to establish a core outcome set and standardize trial designs to enhance research quality.

Objective To analyze the application of outcome indicators and measurement tools in randomized controlled trials(RCTs)of TCM treatment for coronary heart disease(CHD)complicated with anxiety and depression in recent years;To facilitate the construction of core outcome set in this field.Methods The RCTs of TCM treatment for CHD complicated with anxiety and depression were retrieved from CNKI,Wanfang Data,VIP,CBM,PubMed,Web of Science,Embase,Cochrane Library,and the included RCTs were evaluated for bias risk,data extracted and analyzed.Results A total of 163 articles were included,with 157 outcome indicators categorized into 6 indicator domains according to their functional attributes.The application rates in descending order were symptoms and signs(98.16%),physiological and chemical tests(58.90%),TCM syndromes(48.47%),safety events(44.17%),quality of life(39.88%),and long-term prognosis(9.20%).By analyzing the frequency and distribution of outcome indicators,indicator combinations,measurement time points and tools found that the experimental design and the registration of study protocols were ignored,and the diagnosis and evaluation criteria of anxiety and depression and TCM diagnosis/syndrome differentiation were not standardized.The selection of outcome indicators was characterized by lack of comorbidity between CHD and anxiety and depression,no separation of primary and secondary,excessive number of indicators,irregular composite indicators,inconsistent application of TCM-specific indicators,lack of long-term prognosis,safety indicators and health economics evaluation.Conclusion There are some limitations in the RCT design and outcome indicators in the TCM treatment of CHD complicated with anxiety and depression.It is imperative to establish a core outcome set and standardize trial designs to enhance research quality.