Current and future challenges of antithrombotic agents and anticoagulants: Strategies for reversal of hemorrhagic complications.

Recent years have seen the introduction of a number of new anticoagulant agents, each offering a unique profile of benefits and potential drawbacks. Anticoagulants are now available or in development that target platelet recruitment, aggregation, and adhesion, in addition to a growing number of direct or indirect thrombin inhibitors. However, the potential for anticoagulant-induced hemorrhage and the need for effective antidotes that can reverse this adverse effect remain major considerations when prescribing any anticoagulant therapy. The expanding range of anticoagulants brings with it a renewed challenge of identifying suitable treatments to reverse anticoagulant-induced hemorrhage. This paper reviews different mechanisms of anticoagulant action and the theoretical role of recombinant factor VIIa (rFVIIa) and other agents currently in development to reverse bleeding complications associated with both traditional and novel anticoagulant therapies.