![]() Heparin Neutralization During Extracorporeal Circulation† IVġ.5 mg for every 100 units of heparin sodium administered. A loading dose of 25–50 mg by slow IV infusion suggested by some clinicians, with remainder of calculated dose administered by continuous IV infusion † over 8–16 hours or expected duration of absorption of heparin. Severe bleeding occurring after sub-Q injection of heparin: Some clinicians recommend 1–1.5 mg for every 100 units of heparin sodium prolonged infusion may be required to neutralize sub-Q heparin dose. Severe bleeding occurring ≥2 hours after IV injection of heparin: 0.25–0.375 mg for every 100 units of heparin sodium administered. Severe bleeding occurring 30 minutes after IV injection of heparin: 0.5 mg for every 100 units of heparin sodium administered. Severe bleeding occurring a few minutes after IV injection of heparin: 1 mg for every 100 units of heparin sodium administered. DosageĪvailable as protamine sulfate dosage expressed in terms of the salt. Rate of AdministrationĪdminister by very slow IV injection over 10 minutes. Contains no preservatives discard unused portion. However, if more dilute infusion solution is desired, further dilution in 5% dextrose or 0.9% sodium chloride injection recommended. May be administered without further dilution at a concentration of 10 mg/mL. ![]() Has been administered by continuous IV infusion †. (See Sensitivity Reactions under Cautions.) A maximum of about 60–75% or 60% of anti-factor X a activity is neutralized with protamine sulfate administration for overdosage of dalteparin or enoxaparin, respectively.įor solution and drug compatibility information, see Compatibility under Stability.Īdminister by very slow IV injection. Low Molecular Weight Heparin Overdosage† ĭose of protamine sulfate determined by dose of LMW heparin received, the time elapsed since the drug was given, and blood coagulation studies.įollowing higher doses of protamine sulfate, aPTT may remain more prolonged than would be the case following treatment of heparin overdosage since anti-factor X a activity is never completely neutralized. (See Effects on Hemostasis under Cautions.) Monitor therapeutic response through coagulation studies (aPTT, activated coagulation time, heparin titration test with protamine, plasma thrombin time).Īdditional doses of protamine sulfate may be required in patients with heparin rebound (e.g., as may occur during extracorporeal circulation † in arterial and cardiac surgery or dialysis procedures) if indicated by coagulation studies. Generally, 1 mg of protamine sulfate will neutralize no less than 100 units of heparin sodium.īlood heparin concentrations decrease rapidly after IV administration of heparin dose of protamine sulfate required in the treatment of IV heparin overdosage also decreases rapidly as time elapses. Blood transfusions may be required for massive blood loss.ĭose of protamine sulfate determined by dose of heparin received, route of administration, time elapsed since heparin was given, and blood coagulation studies. With severe heparin overdosage, discontinue heparin and administer protamine sulfate immediately. (See Actions.) Protamine Dosage and Administration General Heparin Overdosage However, neutralization of an LMW heparin is not complete even with multiple doses of protamine. Has been used for treatment of low molecular weight (LMW) heparin (e.g., dalteparin, enoxaparin, tinzaparin ) overdosage †. Neutralization of anticoagulant effect of heparin to reduce risk of bleeding near delivery † in pregnant women receiving heparin therapy who go into spontaneous labor. Heparin Neutralization in Pregnant Women Near Delivery Neutralization of heparin administered during extracorporeal circulation † in arterial and cardiac surgery or dialysis procedures. Heparin Neutralization during Extracorporeal Circulation (See Boxed Warning.) Heparin withdrawal usually corrects minor overdosage or bleeding within a few hours. ![]() Uses for Protamine Heparin Overdosageĭo not use for minor bleeding during heparin therapy. Heparin antagonist prepared from the sperm or mature testes of salmon or related species. Protamine should not be used for bleeding that occurs without prior exposure to heparin. Administer only when facilities and equipment for treatment of such reactions are readily available. Weigh risk against anticipated benefit of protamine therapy in patients with risk factors. Other possible risk factors include known sensitivity to fish, vasectomy, severe left ventricular dysfunction, and abnormal pulmonary hemodynamics. Possible severe hypotension, cardiovascular collapse, noncardiogenic pulmonary edema, catastrophic pulmonary vasoconstriction, and pulmonary hypertension with rapid IV injection, high doses, repeated doses, or previous exposure to protamine or protamine-containing drugs (e.g., insulin). ![]()
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