Antithrombotic Reversal Agents

Abstract

Antithrombotic therapy comprising of either anticoagulants, antiplatelets, or fibrinolytic agents is commonly being prescribed worldwide for the prevention and treatment of thromboembolic events. However, despite having a morbidity and mortality benefit, these agents have an innate potential of bleeding risk, thereby increasing the propensity for major bleeds like intracranial hemorrhage. In recent years, several new antithrombotic agents have been introduced into clinical practice which presents unique challenges in the emergency reversal of their coagulopathy. In life-threatening situations, the antithrombotic reversal agents tilt the delicate balance of the coagulation cascade back toward thrombosis just long enough to stop the bleeding or facilitate an emergenent or urgent surgical intervention. The recent approval of specific reversal agents has provided new drugs in the neurosurgical armamentarium in combatting antithrombotic-induced coagulopathy. In this chapter we discussed the varied existing and new reversal agents in pipeline for the emergency reversal of antithrombotic agents in the setting of intracranial hemorrhage and need of urgent neurosurgical intervention.