If you’re unlucky enough to suffer intracranial bleeding, your unluckiness is compounded if you’re concurrently taking any sort of anticoagulation. Some agents have relatively-effective reversal options – typically prothrombin concentrate complexes or fresh frozen plasma. Anti-platelet agents, however, tend to irreversibly bind and inactivate platelets – and the only theoretical reversal strategy is transfusion with new, unblemished platelets.
That definitely won’t work for ticagrelor.
This brief letter in the NEJM details the unfortunate case of a man suffering a hemorrhagic transformation following a stroke while on ticagrelor. As part his treatment, these authors transfused the patient a total of 17 units of platelets. After said transfusion, the platelet-reactivity index barely rose from 0% to approximately 10% immediately following the transfusion – but then returned to 0% an hour later, and remained unchanged at 0% seven hours later when rechecked. As you might expect, with 0% platelet activity, the patient expired as a result of his intracranial bleeding.
If you can manage not to waste blood products in such futile action, please do so. Also, beware!
“Inefficacy of Platelet Transfusion to Reverse Ticagrelor”
http://www.ncbi.nlm.nih.gov/pubmed/25564918
It's just one case, however. Do we have animal or in vtro studies of any help?