Diagnosis:
Heparin reversal with protamine sulfate
• Unfractionated heparin (UFH) accelerates the anticoagulant activity of antithrombin, which inactivates factors Xa, IIa (thrombin), IXa, and XIa.
• UFH has a half-life of 1 hour, so it takes 5 to 6 hours to be cleared.
• UFH can be reversed by administering protamine, which is an arginine-rich (positively charged) protein that binds to the negatively charged heparin.
• Dosing of protamine for heparin reversal: administer 100 mg of protamine for each 100 IU/mL of heparin activity.
• The main side effect of protamine is allergic reactions that can be severe (anaphylaxis). It can also cause hypotension, bradycardia, and hypertension/pulmonary hypertension.
• Protamine is also used to reverse the anticoagulant effect of low-molecular-weight heparin, but it only partially reverses the effect of low-molecular-weight heparin.
