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)
• 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)

See Also

• Coagulopathy (Main)
• Unfractionated heparin