Liverpool Hospital Emergency Department
- Bleeding and over-anticoagulation from Unfractionated heparin
- Reversal of Heparin anticoagulation after renal dialysis, before surgery, after open heart surgery.
- Potential reversal of low molecular weight heparin in haemorrhage situations.
- 50mg/5mL ampoules (10mg/ml)
Dosage and Administration
- Heparin anticoagulation reversal: (1mg per 100units of heparin)
- Dilute 100mg in 100mL sodium chloride 0.9% or 5% dextrose and infuse over 1 hour
- Heparin overdose:
- (1mg per 100units of heparin)
- Dilute 50mg in 100mL sodium chloride 0.9% and infuse over 1-hour
- Dosing should be correlated with APTT and clinical evidence of bleeding with heparin overdose
- Enoxaparin Reversal:
- Administer 1 mg of protamine sulfate for every 1 mg of enoxaparin administered in the previous 8 hours.
- Heparin is continuously excreted; thus, dosage is to be reduced if more than 15minutes have elapsed since the heparin injection.
- In a situation where rapid reversal is necessary a slow IV injection over 10 mins is acceptable.
- Hypotension, flushing, pulmonary oedema and bradycardia
- Contraindicated: Allergy to protamine sulphate and/or fish.
- At high concentrations, Protamine will act as an anticoagulant.
- Not recommended for danaparoid overdose.