Aim: Pharmacologic agents with procoagulant effects and antidotes against antithrombotic drugs play
an important role in the prevention and management of perioperative coagulopathic bleeding. The aim of this
narrative review is knowledge transfer from new and renewed hemostatic agents to anesthesiologists and other
physicians involved in perioperative medicine.
Methods: The literature search was performed on PubMed and the Summaries of Product Characteristics of 6
pharmacologic agents of interest: fibrinogen concentrate, vonicog alfa, susoctocog alfa, idarucizumab, andexanet
alfa, and argatroban.
Results and Discussion: This review highlights renewed interest in fibrinogen concentrate, an old prohemostatic
drug, in correcting hypofibrinogenemia which is a leading pathomechanism of perioperative bleeding.
This review describes clinically relevant aspects for brand new recombinant prohemostatic drugs for their use in
critical clinical situations: vonicog alfa for the prevention and correction of bleeding in von Willebrand syndrome,
and susoctocog alfa in acquired hemophilia A.
Clinical experience and increasing evidence broadened the field of applications of the old antithrombotic drug
argatroban to heparin resistance.
New antidotes against new antithrombotic agents revolutionized the safety of chronic antithrombotic therapy in
the emergency situations of acute and trauma surgery.
Information on dosing and handling of new hemostatic drugs is summarized.
Conclusion: New and potent hemostatic agents exist for perioperative use and may enrich the armamentarium of
anesthesiologists. Implementation into clinical practice requires their availability and user knowledge. Sustainability
of these new drugs depends on post-licensing research, cost-effectiveness, and clinical experience.