Unfractionated heparin reversal: Difference between revisions
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==Background== | ==Background== | ||
*Managed according to clinical severity, NOT PTT value | *Managed according to clinical severity of bleeding, NOT PTT value | ||
**Heparin-associated bleeding is not always reflected by a supratherapeutic PTT | **Heparin-associated bleeding is not always reflected by a supratherapeutic PTT | ||
== | ==Indications== | ||
*Significant bleeding while on [[heparin] drip | |||
==Management== | ==Management== | ||
*Stop transfusion | *Stop transfusion | ||
*Observation alone may be appropriate in less severe cases | *Observation alone may be appropriate in less severe cases | ||
*Protamine | *[[Protamine]] | ||
**Only indicated for major bleeding (0.2% of patients develop severe anaphylaxis) | **Only indicated for major bleeding (0.2% of patients develop severe anaphylaxis) | ||
{{Heparin reversal}} | |||
*[[hemorrhage|Massive bleed]] | |||
**[[Cryoprecipitate]] (10 U IV), then [[FFP]] (& platelets, aminocaproic acid infusion if nec) | |||
*Massive bleed | |||
**Cryoprecipitate (10 U IV), then [[FFP]] (& platelets, aminocaproic acid infusion if nec) | |||
==Disposition== | ==Disposition== | ||
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[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
[[Category:Pharmacology]] | |||
Latest revision as of 15:06, 6 July 2022
Background
- Managed according to clinical severity of bleeding, NOT PTT value
- Heparin-associated bleeding is not always reflected by a supratherapeutic PTT
Indications
- Significant bleeding while on [[heparin] drip
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)
- 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
- Cryoprecipitate (10 U IV), then FFP (& platelets, aminocaproic acid infusion if nec)