Emergency management of hemorrhagic complications in the era of glycoprotein IIb/IIIa receptor antagonists, clopidogrel, low molecular weight heparin, and third-generation fibrinolytic agents.

Antithrombotic, antiplatelet, and fibrinolytic agents are the mainstay for the management of patients with acute coronary syndromes (ACS). In addition to their well-documented efficacy, these pharmacologic agents have the potential for the untoward effect of bleeding. Recent data suggest medication errors related to the dose, duration, and concomitant use of these agents contribute to increasing the risk of hemorrhage in patients treated for ACS. In the event of a major hemorrhage, clinicians should be aware of strategies used to reverse the pharmacologic effects of the offending agent. This paper critically assesses literature directed toward reversal of agents based on drug-specific pharmacodynamic and pharmacokinetic parameters.