Anticoagulants and Reversal Agents

Neurocritical care patients are at an increased risk of developing thrombotic complications. Several anticoagulant agents are available to prevent patients from developing a thrombus or to treat patients when thrombosis occurs. Some of these agents are available as oral therapy and others are parenteral. Parenteral agents are preferred to be used in an unstable patient while in the hospital due to their short half-life and reliable absorption, while many oral agents are ideal for stabilized patients preparing to be discharged. When choosing appropriate anticoagulant therapy for a patient, healthcare professionals should consider individual patient characteristics, such as weight, renal and liver function, and concomitant medications. Anticoagulant use may also lead to unwanted bleeding adverse events that require the initiation of anticoagulation reversal strategies. This chapter will focus on anticoagulant pharmacology, pharmacotherapy, advantages and disadvantages, and reversal strategies when life-threatening bleeding occurs.