What Drugs Decrease Perioperative Bleeding?
Perioperative bleeding can lead to increased patient morbidity and mortality. Patients should be assessed for anemia preoperatively and optimized before elective surgery. Management of intraoperative bleeding should be guided by point-of-care, test-driven transfusion algorithms before hemostatic interventions. Pharmacologic agents are available and should be used to reverse specific anticoagulants, such as protamine for heparin, prothrombin complex concentrates for warfarin, idarucizumab for dabigatran reversal, and andexanet alfa for reversal of FXa inhibitors (apixaban and rivaroxaban). There is also evidence for the use of antifibrinolytics in hemorrhage associated with cardiopulmonary bypass, trauma, obstetrics, and major spine surgery. There is a growing body of literature supporting the use of low-dose prothrombin complex concentrates and recombinant factor VIIa in the setting of refractory bleeding.
