Current Anticoagulation Drugs and Mechanisms of Action

Neurosurgical patients currently taking anticoagulation at the time of presentation, elective or emergent, is increasingly common. An understanding of the mechanisms of action of these drugs as well as how to reverse their effect is essential to appropriate and timely care. Vitamin K antagonists, heparins, factor X inhibitors, and direct thrombin inhibitors all pose unique challenges in managing a neurosurgical patient with comorbid conditions. As all these drugs can present with intracranial hemorrhage, knowledge of how and when to rapidly reverse them as best as possible can be life saving.