Counteracting the effects of anticoagulants and antiplatelet agents during neurosurgical emergencies.
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.


CONCLUSIONS
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.
Powner
David J
DJ
Department of Neurosurgery, Vivian L. Smith Center for Neurologic Research, University of Texas Health Science Center at Houston Houston, Texas 77030, USA. david.j.powner@uth.tmc.edu
Hartwell
Elizabeth A
EA
Hoots
W Keith
WK
D000925:Anticoagulants / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects*; D001927:Brain Diseases / Q000601:surgery; D004347:Drug Interactions; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors