New oral anticoagulant and antiplatelet agents for neurosurgeons

Kimpton, George, Dabbous, Bassam and Leach, Paul 2015. New oral anticoagulant and antiplatelet agents for neurosurgeons. British Journal of Neurosurgery 29 (5) , pp. 614-621. 10.3109/02688697.2015.1029433

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Abstract

Until recently, warfarin, clopidogrel and aspirin have provided the mainstay for prevention of thrombotic disease in cardiac patients. However, new classes of drugs have recently emerged that promise better clinical outcomes and lower risks. Use of such agents has increased, but increased risk and severity of intra-cranial haemorrhage (ICH) still remain. These cases of intra-cranial bleeds present as emergencies to neurosurgical units. It is of paramount importance that neurosurgical practitioners are aware of those new drugs, useful monitoring tests and available emergency reversal options in case the patient needs emergency intervention. In this review we survey newly available agents in the UK at the time of publication. We look at the data provided by the manufacturers, related publications and international guidelines for their use and reversal. New anticoagulants offer a lower incidence of ICH compared with warfarin. Advanced and accurate monitoring tests are emerging, as are prospective data on reversal of anticoagulation in bleeding. Some standard coagulation tests may be of use, whilst reversal agents are available and being evaluated. The trial data shows that new antiplatelet agents have similar or increased incidence and severity of intra-cranial ICH compared with clopidogrel. There is currently limited data on monitoring or reversal. We suggest they may be managed similarly to clopidogrel by using platelet reactivity assays, optimising platelet count and using platelet transfusion with adjunctive agents.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General)
Uncontrolled Keywords:	antiplatelets, intra-cranial haemorrhage, neurosurgery, novel oral anticoagulants
Publisher:	Informa Healthcare
ISSN:	0268-8697
Date of Acceptance:	8 March 2015
Last Modified:	08 Jan 2020 04:47
URI:	https://orca.cardiff.ac.uk/id/eprint/84813

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