Can drug-induced platelet dysfunction be reversed?

Maynard, S., Bye, A. P. ORCID: https://orcid.org/0000-0002-2061-2253 and Desborough, M. J.R. (2025) Can drug-induced platelet dysfunction be reversed? Research and Practice in Thrombosis and Haemostasis. 103286. ISSN 2475-0379 doi: 10.1016/j.rpth.2025.103286 (In Press)

Abstract/Summary

Antiplatelet drugs are used for treatment of arterial disease but side effects include an increased risk of bleeding. For patients with intracerebral haemorrhage, traumatic brain injury and lower gastrointestinal bleeding, mortality rates are higher for patients taking antiplatelet drugs. Reversing the effect of antiplatelet drugs may therefore reduce the risk of mortality and morbidity for these conditions. However, the benefits of any reversal agent must be balanced against the risk of thrombotic complications. Platelet transfusion is often used in clinical practice as a reversal agent but the only randomised controlled trial in the setting of intracerebral haemorrhage showed an increased risk of death and disability with platelet transfusion compared to standard care. Tranexamic acid is used in a wide range of conditions to reduce bleeding. The risks and benefits of tranexamic acid appear similar for patients taking antiplatelet drugs compared to no antiplatelet drugs. A feasibility trial of desmopressin for reversing the antiplatelet drug effect in intracerebral haemorrhage showed promising results but definitive efficacy studies are needed. Lastly, unlike other antiplatelet drugs, ticagrelor binds reversibly to platelets. A reversal agent for ticagrelor, bentracimab, has been used in a single arm clinical trial with reversal of the antiplatelet drug effect and good haemostatic outcomes, although without a comparator arm to allow full assessment of efficacy. This review highlights an unmet need for high quality studies assessing the efficacy of reversal strategies in drug-induced platelet dysfunction, using clinically relevant outcomes.

Item Type	Article
URI	https://centaur.reading.ac.uk/id/eprint/127499
Identification Number/DOI	10.1016/j.rpth.2025.103286
Refereed	Yes
Divisions	Life Sciences > School of Chemistry, Food and Pharmacy > School of Pharmacy > Division of Pharmacology
Publisher	Elsevier
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