Unfractionated heparin reversal


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


  • Significant bleeding while on [[heparin] drip


  • Stop transfusion
  • Observation alone may be appropriate in less severe cases
  • Protamine
    • Only indicated for major bleeding (0.2% of patients develop severe anaphylaxis)
  • Major bleeding due to unfractionated heparin:
    • 1 mg IV for every 100 units of heparin infused in past 3h
    • Do not infuse faster than 50mg/10min
    • If it has been >30min since last heparin injection, 0.5mg may be sufficient
    • Give slowly over 1-3min; do not exceed 50mg in any 10 minute period (anaphylaxis risk)
    • Because half-life is short (7 min) may require second treatment
  • Major bleeding due to low-molecular-weight heparin:
    • Protamine is less effective for bleeding from LMWH than it is with heparin-induced bleeds
    • Enoxaparin: 1 mg IV for every 1 mg enoxaparin administered in past 8h
    • Dalteparin: 1 mg IV for every 100 anti-Xa international units of dalteparin
  • Massive bleed


See Also

External Links