Shock Syndromes II

Desmopressin enhances platelet adherence and aggregation.

Although its clinical efficacy is controversial, desmopressin 0.3–0.4 mcg/kg intravenously may be

considered to reverse platelet-inhibiting drugs or von Willebrand disease but may not be routinely

used in trauma patients with bleeding. If administering desmopressin, the 2019 European trauma

guidelines recommend administering an antifibrinolytic (e.g., tranexamic acid) in parallel.

There is a low risk of serious adverse effects, including hypervolemia, hyponatremia, facial

flushing, and rare thrombosis.

Generic Drug

(trade name):

Mechanism of Action

Coagulation Assay

Effects

Usual

Half-Life

(hr)

Duration

of Platelet

Inhibition

Recommendations

Aspirin

Inhibits platelet activation

Irreversible inhibition

of COX-1 and COX-2

enzymes

Optimal platelet

function assay

and thresholds

controversial

Light transmission

platelet aggregation

is gold standard of

platelet function

testing but is not

routinely available

TEG with

platelet mapping,

VerifyNow, platelet

function analyzer,

and bleeding time

may be used

Lifetime of

platelets

5–7 days

Use caution with antiplatelet

reversal in patients with

active or recent (within 3

mo) coronary artery disease

Reversal strategies:

Platelets*

Neurosurgical hemorrhage:

1 apheresis unit (moderate

quality of evidence)

Neurosurgery is not

indicated: Platelet

transfusions controversial

and not recommended by

the Neurocritical Care

Society (low quality of

evidence)

-and/or-

Desmopressin (DDAVP)

0.4 mcg/kg IV push once

(low quality of evidence)

*Transfused platelets with

ticagrelor may become

inhibited because of

reversible activity at the

P2Y12 receptor

Dipyridamole ± aspirin

(Aggrenox, Persantine)

Inhibits platelet activation

Increases endogenous

adenosine

10–12

2–3 days

(dipyridamole)

Lifetime of

platelets 5–7 days

for aspirin

Clopidogrel (Plavix)

Inhibits platelet activation

Active metabolite

irreversibly blocks ADP

Lifetime of

platelets 5–7 days

Prasugrel (Effient)

Inhibits platelet activation

Active metabolite

irreversibly blocks ADP

2–15

Lifetime of

platelets 5–7 days

Ticagrelor (Brilinta)

Inhibits platelet activation

Reversibly blocks ADP

7–9

3–5 days

AA = arachidonic acid; ADP = adenosine diphosphate; COX = cyclooxygenase.

Information from: Levi M, Eerenberg E, Kamphuisen PW, et al. Bleeding risk and reversal strategies for old and new anticoagulants and antiplatelet agents. J

2015;386:281-91; Spahn D, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition.