title: Bleeding risk and reversal strategies for old and new anticoagulants and antiplatelet agents.
abstract: The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. In the case of severe bleeding in a patient who uses anticoagulant agents or when a patient on anticoagulants needs to undergo an urgent invasive procedure, it may be useful to reverse anticoagulant treatment. Conventional anticoagulants such as vitamin K antagonists may be neutralized by administration of vitamin K or prothrombin complex concentrates, whereas heparin and heparin derivatives can be counteracted by protamine sulphate. The anti-hemostatic effect of aspirin and other antiplatelet strategies can be corrected by the administration of platelet concentrate and/or desmopressin, if needed. Recently, a new generation of anticoagulants with a greater specificity towards activated coagulation factors as well as new antiplatelet agents have been introduced and these drugs show promising results in clinical studies. A limitation of these new agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although experimental studies show hopeful results for some of these agents.
authors: Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. m.m.levi@amc.uva.nl
authors: M
authors: M
authors: Levi
authors: E
authors: E
authors: Eerenberg
authors: P W
authors: PW
authors: Kamphuisen
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000037:antagonists & inhibitors*; D000991:Antithrombins / Q000009:adverse effects / Q000037:antagonists & inhibitors; D065427:Factor Xa Inhibitors; D000077425:Fondaparinux; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D006493:Heparin / Q000009:adverse effects; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D019934:International Normalized Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011134:Polysaccharides / Q000009:adverse effects / Q000037:antagonists & inhibitors; D012307:Risk Factors; D014812:Vitamin K / Q000008:administration & dosage / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000009:adverse effects / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D006494:Heparin Antagonists; D010975:Platelet Aggregation Inhibitors; D011134:Polysaccharides; D014812:Vitamin K; D014859:Warfarin; D006493:Heparin; D000077425:Fondaparinux