Haemostasis in shock Part 5: Haemostatically active drugs

For prevention and treatment of thromboembolic events, a number of different potent antiplatelet agents and anticoagulants are avaible for a pharmacological intervention of haemostasis. Despite the proven benefit, the risk of bleeding is one major adverse effect. Therefore, the parallel use of antiplatelet agents such as acetyl salicylic acid, NSAID or ADP receptor antagonists such as clopidogrel may cause pharmacodynamic interactions. Special caution is necessary when further drugs that cause an additional inhibition of platelet function are prescribed, e.g. selective serotonin reuptake inhibitors. After the development of low-molecular-weight heparins, which are associated with a lower risk of thrombocytopenia, the introduction of direct oral anticoagulants (DOAC) provided further options in the prophylaxis of thromoboembolic events. Some DOACs have already gained priority over vitamin K antagonists in cardiology guidelines. However, these drugs also bear/harbour the risk of drug-drug interactions and, to some extent, require a close monitoring of renal function. First antidots have already been approved or are awaiting approval.