Reversal of Systemic Anticoagulants and Antiplatelet Therapeutics

David Dornbos 3rd; Shahid M Nimjee

doi:10.1016/j.nec.2018.06.005

Reversal of Systemic Anticoagulants and Antiplatelet Therapeutics

Neurosurg Clin N Am. 2018 Oct;29(4):537-545. doi: 10.1016/j.nec.2018.06.005.

Authors

David Dornbos 3rd¹, Shahid M Nimjee²

Affiliations

¹ Department of Neurological Surgery, Ohio State University Medical Center, N-1014 Doan Hall, 410 West 10th Avenue, Columbus, OH, USA.
² Department of Neurological Surgery, Ohio State University Medical Center, N-1014 Doan Hall, 410 West 10th Avenue, Columbus, OH, USA. Electronic address: shahid.nimjee@osumc.edu.

PMID: 30223966
DOI: 10.1016/j.nec.2018.06.005

Abstract

Although antiplatelet medications and anticoagulants are necessary for numerous cardiac comorbidities, prevention of stroke, and treatment and prevention of venous thromboembolic events, they pose a significant treatment dilemma in neurosurgical patients, particularly in the setting of intracranial hemorrhage or prior to emergent neurosurgical procedures. For the majority of current anticoagulation and antiplatelet therapies, no direct reversal agents exist; however, there are numerous strategies that can be used to reverse or mitigate their antithrombotic properties. This review provides a comprehensive summary of the latest antiplatelet and anticoagulant therapies and the role of emergency reversal prior to emergent neurosurgical procedures.

Keywords: Anti-platelet; Anticoagulation; Intracranial hemorrhage; Stroke.

Publication types

Review

MeSH terms

Anticoagulants / adverse effects*
Humans
Intracranial Hemorrhages / drug therapy*
Neurosurgical Procedures / methods
Platelet Aggregation Inhibitors / adverse effects*
Treatment Outcome

Substances

Anticoagulants
Platelet Aggregation Inhibitors