Key result
Administration of reversal agents like platelet transfusions, FFP, vitamin K, and protamine can treat coagulopathies caused by antithrombotic drugs during neurosurgical emergencies.
Why the study?
How can the effects of anticoagulants and antiplatelet agents be reversed during neurosurgical emergencies?
How can the effects of anticoagulants and antiplatelet agents be reversed during neurosurgical emergencies?
This review provides recommendations for reversing various anticoagulant and antiplatelet agents in the setting of emergent neurosurgery.
May guide reversal in antithrombotic neurosurgical emergencies; leaves open need for prospective validation of protocols.
OBJECTIVE: Emergent neurosurgery may be precipitated or complicated by previous or concomitant administration of anticoagulants, thrombolytic medications, or antiplatelet agents. Recommendations are presented to reverse or counteract the effects of those drugs before or during neurosurgical interventions. METHODS: Directed literature review. RESULTS: Evidence-based data specific to neurosurgery are limited. CONCLUSION: Other clinical experience based on mechanisms of drug action within the coagulation process confirm that single or combined administration of platelet transfusions, fresh frozen plasma, cryoprecipitate, vitamin K, protamine, desmopressin, and recombinant activated factor VII can treat coagulopathies caused by warfarin, heparin, aspirin, adenosine diphosphate-receptor antagonist, glycoprotein IIb/IIIa receptor blocking agents, and thrombolysis. Specific interventions and recommended dosages are reviewed.
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Powner et al. (2005) conducted a review in Neurosurgical emergencies complicated by anticoagulants, thrombolytics, or antiplatelet agents. Reversal agents (platelet transfusions, fresh frozen plasma, cryoprecipitate, vitamin K, protamine, desmopressin, recombinant activated factor VII) was evaluated. Administration of reversal agents like platelet transfusions, FFP, vitamin K, and protamine can treat coagulopathies caused by antithrombotic drugs during neurosurgical emergencies.
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