Antiplatelet drugs in critical care: What Doctors need to know

Abstract

Antiplatelet agents play a crucial role in preventing arterial thrombotic complications in ischemic high-risk patients. However, their use in intensive care faces a major challenge: the increased risk of bleeding, particularly in patients with organs failure, haemostasis disorders or requiring circulatory assistance (ECMO). A careful and dynamic assessment of the balance between ischemic benefit and bleeding risk is essential. In case of acute thrombotic event, dual antiplatelet therapy is sometime mandatory. At the opposite, cautious use is recommended when antiplatelet agents are associated with anticoagulation or in patients with ECMO. Recent guidelines emphasize shortening the duration of antiplatelet therapy to reduce the bleeding risk in patients with anticoagulation treatment. Finally, management of bleeding under antiplatelet therapy remains a challenge in the absence of an antidote and due to the frequent need to quickly resume antiplatelet treatment. A good knowledge of pharmacodynamic and pharmacokinetic of antiplatelet drugs could help to optimize individualized antiplatelet treatment in each situation.