Role of Platelet Transfusion in the Reversal of Anti-Platelet Therapy

Transfus Med Rev. 2019 Apr;33(2):92-97. doi: 10.1016/j.tmrv.2019.01.002. Epub 2019 Jan 25.

Abstract

Antiplatelet therapy is extensively used in the primary and secondary prophylaxis of arterial thrombotic disorders. Aspirin, the most commonly used antiplatelet agent, is a cyclooxygenase-1 inhibitor and considered a mild to moderate inhibitor of platelet function. Therefore, often a second antiplatelet agent is necessary in certain clinical conditions requiring greater inhibition of platelet function. An adenosine diphosphate (ADP) receptor, P2Y12, is an important target for this purpose; several agents inhibit this receptor providing potent antiplatelet effect. One of the side effects of these agents is bleeding, which in some patients may require reversal of antiplatelet effect. Similarly, patients undergoing emergent surgeries may benefit from reversal of antiplatelet effect to avoid excessive surgical bleeding. This article reviews current literature on this topic.

Keywords: Antiplatelet therapy; Aspirin; P2Y12 inhibitors; Platelet transfusion.

Publication types

  • Review

MeSH terms

  • Aspirin / therapeutic use
  • Blood Loss, Surgical
  • Blood Platelets / drug effects
  • Cyclooxygenase Inhibitors / pharmacology
  • Hemorrhage / chemically induced
  • Hemorrhage / drug therapy*
  • Hemostasis / drug effects
  • Humans
  • Phosphodiesterase Inhibitors / pharmacology
  • Platelet Aggregation Inhibitors / adverse effects*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Function Tests
  • Platelet Transfusion / methods*
  • Purinergic P2Y Receptor Antagonists / therapeutic use
  • Receptors, Purinergic P2Y12 / metabolism
  • Thromboembolism / prevention & control
  • Ticagrelor / adverse effects

Substances

  • Cyclooxygenase Inhibitors
  • P2RY12 protein, human
  • Phosphodiesterase Inhibitors
  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists
  • Receptors, Purinergic P2Y12
  • Ticagrelor
  • Aspirin