Unfractionated heparin reversal

Background

  • Managed according to clinical severity, NOT PTT value
    • Heparin-associated bleeding is not always reflected by a supratherapeutic PTT

Clinical Features

Differential Diagnosis

Workup

Management

  • Stop transfusion
  • Observation alone may be appropriate in less severe cases
  • Protamine
    • Only indicated for major bleeding (0.2% of patients develop severe anaphylaxis)
    • Give 1mg IV for every 100 units of UFH infused in the prior 3hr
    • Give slowly over 1-3min; do not exceed 50mg in any 10 minute period
    • Because half-life is short (7 min) may require second treatment
  • Massive bleed
    • Cryoprecipitate (10 U IV), then FFP (& platelets, aminocaproic acid infusion if nec)

Disposition

See Also

External Links

References