Emergency management of hemorrhagic complications in the era of glycoprotein IIb/IIIa receptor antagonists, clopidogrel, low molecular weight heparin, and third-generation fibrinolytic agents.
Antithrombotic, antiplatelet, and fibrinolytic agents are the mainstay for the management of patients with acute coronary syndromes (ACS). In addition to their well-documented efficacy, these pharmacologic agents have the potential for the untoward effect of bleeding. Recent data suggest medication errors related to the dose, duration, and concomitant use of these agents contribute to increasing the risk of hemorrhage in patients treated for ACS. In the event of a major hemorrhage, clinicians should be aware of strategies used to reverse the pharmacologic effects of the offending agent. This paper critically assesses literature directed toward reversal of agents based on drug-specific pharmacodynamic and pharmacokinetic parameters.
Schroeder
Walter S
WS
Massachusetts College of Pharmacy and Health Sciences, 19 Foster Street, Worcester, MA 01608, USA.
Gandhi
Pritesh J
PJ
D000208:Acute Disease; D000789:Angina, Unstable / Q000188:drug therapy*; D000077144:Clopidogrel; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000009:adverse effects* / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D013577:Syndrome; D013988:Ticlopidine / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine