Reversal and removal of oral antithrombotic drugs in patients with active or perceived imminent bleeding

Davide Cao, Nicolas Amabile, Mauro Chiarito, Victoria T. Lee, Dominick J. Angiolillo, Davide Capodanno, Deepak L. Bhatt, Michael J. Mack, Robert F. Storey, Michael Schmoeckel, C. Michael Gibson, Efthymios N. Deliargyris, Roxana Mehran

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

Remarkable progress has been made in the pharmacological management of patients with cardiovascular disease, including the frequent use of antithrombotic agents. Nonetheless, bleeding complications remain frequent and potentially life-Threatening. Therapeutic interventions relying on prompt antithrombotic drug reversal or removal have been developed to assist clinicians in treating patients with active bleeding or an imminent threat of major bleeding due to urgent surgery or invasive procedures. Early phase studies on these novel strategies have shown promising results using surrogate pharmacodynamic endpoints. However, the benefit of reversing/removing antiplatelet or anticoagulant drugs should always be weighed against the possible prothrombotic effects associated with withdrawal of antithrombotic protection, bleeding, and surgical trauma. Understanding the ischemic-bleeding risk tradeoff of antithrombotic drug reversal and removal strategies in the context of urgent high-risk settings requires dedicated clinical investigations, but challenges in trial design remain, with relevant practical, financial, and ethical implications.

Original languageEnglish
Pages (from-to)1780-1794
Number of pages15
JournalEuropean Heart Journal
Volume44
Issue number20
DOIs
StatePublished - 21 May 2023

Keywords

  • Antiplatelet therapy
  • Antithrombotic drugs
  • Bleeding
  • Oral anticoagulants
  • Removal
  • Reversal
  • Surgery

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