Anticoagulant-antidote drug pair shows promise in reducing postsurgical bleeding risks

Every year, millions of patients undergoing surgical procedures are at risk of complications related to thrombosis – the local clotting of blood in the circulatory system that can damage vital organs. Shahid Nimjee, MD, PhD, assistant professor of Neurological Surgery, Radiology and Neuroscience at Ohio State, is working with colleagues to develop the first antidote-controllable antiplatelet medication that could stave off thrombosis.

To prevent clots or keep existing clots from getting larger, patients are often prescribed antiplatelets or anticoagulants. A common concern related to these medications is that they are difficult to "turn off" and patients can experience hemorrhage, or excessive bleeding. "Right now we really only use aspirin, because using anything more risks brain bleeding that is difficult to control," says Nimjee.

For the past 15 years, Nimjee has been searching for alternatives to the most commonly prescribed anticoagulant-antidote pair, heparin and protamine, which are associated with an array of complications and are not well tolerated by certain groups of patients.

By taking advantage of the versatility of RNA molecules, Nimjee's group has developed a drug-antidote pair that show promise as a safer regimen to prevent thrombosis during surgery. The first molecule inhibits platelet function, while the second molecule, given a short time later, turns off the first molecule within minutes, completely reversing antiplatelet activity and preventing hemorrhage.

"This one-two punch can help us create better safety profile drugs for improved outcomes for patients who suffer from stroke and atherosclerotic disease," says Nimjee.