Gepost in: Hematologie
Bleeding risk and reversal strategies for old and new anticoagulants and antiplatelet agents
The most important adverse effect of antithrom-botic treatment is the occurrence of bleeding. In the case ofsevere bleeding in a patient who uses anticoagulant agents orwhen a patient on anticoagulants needs to undergo an urgentinvasive procedure, it may be useful to reverse anticoagulanttreatment. Conventional anticoagulants such as vitamin Kantagonists may be neutralized by administration of vitamin Kor prothrombin complex concentrates, whereas heparin andheparin derivatives can be counteracted by protamine sulphate.The anti-hemostatic effect of aspirin and other antiplateletstrategies can be corrected by the administration of plateletconcentrate and/or desmopressin, if needed. Recently, a newgeneration of anticoagulants with a greater specificity towardsactivated coagulation factors as well as new antiplatelet agentshave been introduced and these drugs show promising results inclinical studies. A limitation of these new agents may be the lackof an appropriate strategy to reverse the effect if a bleeding eventoccurs, although experimental studies show hopeful results forsome of these agents.
M. LEVI, E. EERENBERG and P. W. KAMPHUISEN
Journal of Thrombosis and Haemostasis,9: 1705–1712DOI: 10.1111/j.1538-7836.2011.04432.x