UMEM Educational Pearls

Category: Vascular

Title: Reversal of Heparin

Keywords: HeparinPro (PubMed Search)

Posted: 10/20/2008 by Rob Rogers, MD (Updated: 12/9/2019)
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Anticoagulation with Heparin-How to Reverse?

So you just started Heparin on that ACS patient? Just bolused the patient in room 12 with the large PE with a slug of Heparin? The nurse tells you that one of them just vomited blood and the other just had a large bloody bowel movement. What to do, oh, what to do?

How to reverse Heparin...use Protamine:

  • Protamine is obtained from the sperm of salmon and other species of fish....glad you know that now?
  • Given IV, it binds to Heparin (Unfractionated Heparin) and inactivates it
  • Administer Protamine (IV) at a dose of 1 mg for every 100 Units of Heparin given within the last four hours. Max dose 50 mg of Protamine. May give more than 50 mg, but use caution as may lead to bleeding
  • If the dose of Protamine is exceeded, patients may bleed. Protamine is actually an anticoagulant. 
  • Give slowly over 10 minutes as may cause anaphylactoid reaction
  • Can use to reverse LMWH as well: 1mg Protamine per 1 mg of LMWH (Lovenox)