Reversal of Systemic Anticoagulants and Antiplatelet Therapeutics

Although antiplatelet medications and anticoagulants are necessary for numerous cardiac comorbidities, prevention of stroke, and treatment and prevention of venous thromboembolic events, they pose a significant treatment dilemma in neurosurgical patients, particularly in the setting of intracranial hemorrhage or prior to emergent neurosurgical procedures. For the majority of current anticoagulation and antiplatelet therapies, no direct reversal agents exist; however, there are numerous strategies that can be used to reverse or mitigate their antithrombotic properties. This review provides a comprehensive summary of the latest antiplatelet and anticoagulant therapies and the role of emergency reversal prior to emergent neurosurgical procedures.