New Hemostatic Agents: Perioperative Anesthetic Considerations

Area of Science:

• Anesthesiology
• Hematology
• Pharmacology

Background:

• Perioperative coagulopathic bleeding is a significant clinical challenge.
• Pharmacologic agents with procoagulant effects and antidotes against antithrombotic drugs are crucial for management.
• Knowledge transfer regarding these agents is vital for physicians in perioperative medicine.

Purpose of the Study:

• To provide knowledge transfer on new and renewed hemostatic agents and antidotes to anesthesiologists and other physicians.
• To review the clinical relevance and applications of specific procoagulant and antithrombotic agents.

Main Methods:

• A narrative review of literature.
• Literature search performed on PubMed.
• Summaries of Product Characteristics for six pharmacologic agents were reviewed: fibrinogen concentrate, vonicog alfa, susoctocog alfa, idarucizumab, andexanet alfa, and argatroban.

Main Results:

• Renewed interest in fibrinogen concentrate for hypofibrinogenemia.
• Description of new recombinant drugs: vonicog alfa for von Willebrand syndrome and susoctocog alfa for acquired hemophilia A.
• Expanded use of argatroban for heparin resistance and new antidotes for antithrombotic therapy safety.

Conclusions:

• New potent hemostatic agents are available for perioperative use.
• Clinical implementation requires availability and user knowledge.
• Sustainability depends on post-licensing research, cost-effectiveness, and clinical experience.