Anticoagulation Reversal

Chapter

Abstract

Anticoagulant therapy has been commonly prescribed for the prevention and treatment of arterial and venous thromboembolism. But the proven benefits of such therapy have to be outweighed against the risks of major bleeding complications. Such risk varies according to age and has been reported to be as low as 2–3% per year in adults to as high as 6–8% per year in the elderly. Reversal strategies are important both for the treatment of such major hemorrhagic complications and also for minimizing the risk of major bleeding in patients who require emergent invasive procedures while on anticoagulation. While the first-generation anticoagulants—unfractionated heparin and vitamin K antagonists—exert their anticoagulant effects by inhibiting several different proteins involved in normal hemostasis, the latest generation of anticoagulant drugs has a target-specific mechanism of action with predominant or exclusive inhibition of one coagulation protein. As a result, the most common reversal strategies for the treatment and prevention of bleeding caused by older anticoagulants are based on the use of drugs and/or blood products that replace and/or boost the synthesis of coagulation proteins inhibited by those anticoagulants, whereas more target-specific reversing agents are being developed to neutralize the anticoagulant effect of contemporary, target-specific anticoagulants. In this chapter, we will review the efficacy and safety of currently available strategies for reversal of anticoagulants old and new, as well as the preliminary evidence available for reversal strategies that are currently in advanced stages of clinical development.

Keywords

Anticoagulation Reversal Warfarin Prothrombin complex concentrate (PCC) Fresh frozen plasma Vitamin K Recombinant factor VIIa Heparin Unfractionated heparin Low-molecular-weight heparin Fondaparinux Direct thrombin inhibitors Direct oral anticoagulants Protamine Idarucizumab Andexanet alfa 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiovascular Medicine, Section of Vascular MedicineCleveland ClinicClevelandUSA

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