Unfractionated heparin reversal

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)
  • 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)

See Also

• Coagulopathy (Main)
• Unfractionated heparin