Shahid Nimjee, MD, PhD, The Ohio State College of Medicine, Columbus, OH, evaluates some of the key considerations when conducting clinical trials looking at surgical interventions for intracranial hemorrhage (ICH). One of the most important considerations is whether the patient has iatrogenic coagulopathy i.e. they are on an antithrombotic therapy, such as anticoagulants or antiplatelet agents, which has precipitated the hemorrhage. In this case, these therapies must be reversed. One problem with this is that some types of drugs are irreversible and have no reversal agent. For example, clopidogrel and prasugrel are types of P2Y12 inhibitors that irreversibly bind to P2Y12 receptors. Effective reversal agents for these P2Y12 inhibitors are currently being investigated by companies such as PhaseBio (bentracimab). Dr Nimjee believes that the availability of reversal agents would change the way that P2Y12 inhibitors are prescribed by making it easier to reverse the therapy in cases of ICH. This interview took place at the World Stroke Congress 2022 in Singapore.
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