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Practical Guide for Anticoagulant and Antiplatelet Reversal in Clinical Practice

Mohammed Aldhaeefi1, Hisham A Badreldin2,3,4, Faisal Alsuwayyid5

  • 1Department of Clinical and Administrative Pharmacy Sciences, Howard University College of Pharmacy, Washington, DC 20059, USA.

Pharmacy (Basel, Switzerland)
|February 24, 2023
PubMed

Insights

Bleeding is a major concern with increased anticoagulant and antiplatelet use. This guide details reversing agents for antithrombotics like direct oral anticoagulants (DOACs) and direct thrombin inhibitors (DTIs) in emergencies.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Anticoagulant and antiplatelet therapies are increasingly prescribed for cardiovascular conditions.
  • Bleeding complications remain a significant concern for patients on antithrombotic medications.
  • Existing reversal strategies for some antithrombotics are limited, especially for antiplatelet agents.

Purpose of the Study:

  • To provide a practical clinical guide on reversing anticoagulants and antiplatelets.
  • To summarize current evidence and recommendations for antithrombotic reversal.
  • To address the management of bleeding risks associated with antithrombotic therapy.

Main Methods:

  • Review of recent studies and clinical guidelines on antithrombotic reversal.
  • Analysis of available reversal agents for different classes of antithrombotics.
  • Discussion of specific reversal agents such as Vitamin K, PCCs, andexanet alfa, idarucizumab, and protamine sulfate.

Main Results:

  • Direct oral anticoagulants (DOACs) and direct thrombin inhibitors (DTIs) have specific reversal agents (andexanet alfa and idarucizumab, respectively).
  • Warfarin reversal can be achieved with Vitamin K and prothrombin complex concentrate (PCCs).
  • Protamine sulfate is indicated for heparin reversal, but no specific reversal agents exist for antiplatelets.

Conclusions:

  • Effective reversal strategies are crucial for managing bleeding emergencies in patients on antithrombotics.
  • The availability of specific reversal agents varies by antithrombotic class.
  • Further research is needed to develop reversal agents for antiplatelet medications.

Keywords:
health improvementhealth promotionhealth protectioninterventionspharmacistpharmacy technician

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