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)