Emergency Reversal Strategies for Anticoagulation and Platelet Disorders

Bleeding is the most important adverse effect of antithrombotic treatment and may be a major cause of morbidity, longstanding debilitation, and even mortality. In the case of severe hemorrhage in a patient who uses anticoagulant agents, it may be crucial to reverse anticoagulant treatment. Conventional anticoagulants such as vitamin K antagonists can be neutralized by the administration of vitamin K or prothrombin complex concentrates, whereas heparin and heparin derivatives can be counteracted by protamine sulfate. The antihemostatic effect of aspirin and other antiplatelet strategies can be corrected by the administration of platelet concentrate and/or desmopressin. Recently, a new generation of anticoagulants with a greater specificity toward activated coagulation factors as well as new antiplatelet agents have been introduced, and these drugs show efficacy and safety profiles that are at least as good as those of conventional agents in clinical studies. A limitation of these new agents may be the lack of a specific strategy to reverse their effects if a bleeding event occurs, although experimental studies show encouraging results for some of these agents.