Reversing Unfractionated Heparin (UFH)

No Active Bleeding or Minor Bleeding

UFH has a short half life (about 30 minutes). If the APTT is prolonged excessively but there is no active bleeding or minor bleeding, stop the heparin infusion.

Major Bleeding:

· Stop heparin infusion

· Administer protamine sulphate IV 1mg per 100 iu of heparin infused over the previous hour

· The protamine dose should be halved if the heparin infusion has been stopped for 1 hour

· The protamine dose should be reduced to a quarter if the heparin infusion has been  stopped for 2 hours

· Protamine should not be administered at a rate exceeding 5 mg / minute

· Adverse effects of protamine include a fall in blood pressure, bradycardia, dyspnoea and flushing

· Recheck APTT 15 minutes after protamine infusion

In life Threatening Bleeding:

· Rapid and complete reversal of anticoagulation is required

· Remember that blood transfusion may be required

· Treatment with protamine may have to be repeated

· Protamine sulphate may act as an anticoagulant if given in excess.  If you are uncertain what dose to use discuss with a haematologist

· Protamine should not be administered at a rate exceeding 5 mg / minute

· Adverse effects of protamine include a fall in blood pressure, bradycardia, dyspnoea and flushing

· Recheck APTT 15 minutes after protamine infusion

Time Elapsed Since Heparin Infusion Stopped
Protamine Dose	< 15 mins	30 mins	60 mins	> 2 hrs	4 hrs
	Img  protamine / 100 u heparin infused previous hr	0.75 mg protamine / 100 u heparin infused previous hr	0.5 mg protamine / 100 u heparin infused previous hr	0.25 mg protamine / 100 u heparin infused previous hr	May not be required (due to half-life of heparin)