Stop warfarin for 1 – 2 days, until INR has fallen to therapeutic levels and bleeding has stopped.If restarting anticoagulant therapy, this would normally involve prophylactic doses of LMWH initially, gradually increasing to therapeutic doses before switching to an oral anticoagulant.
If INR is 1.5–1.9, consideration can be given to administering a small dose of Beriplex ® (e.g.Protamine sulphate – the anticoagulant effects of LMWH are not completely reversed by protamine sulphate, but this drug should be considered if patients are suffering significant haemorrhage following recent (6 Most LMWHs have an elimination half-life of around 2 – 4 hours following subcutaneous injection, although this can be prolonged in renal failure. Subcutaneous low molecular weight heparin (LMWH) Avoid protamine in patients with allergies to fish or fish products. Protamine sulphate 1mg neutralises 100units of heparin.Īdminister protamine up to a maximum of 50mg in a single dose as slow IV infusion over 10 minutes (anaphylaxis has been reported, see the Anaphylaxis guideline for management). Protamine sulphate – this is only required in severe bleeding cases where there is likely to be a large amount of circulating heparin.It has a short elimination half-life of 30–90 minutes, although may be longer in renal failure. General management and drug therapy Heparin reversal Intravenous unfractionated heparin vitamin K may be needed (dosing details can be found below). If the patient is being anticoagulated with warfarin, a small dose of reversing agent i.e.
Patients with minor bleeding, or over-anticoagulated without any bleeding, will usually require temporary cessation of anticoagulant therapy to achieve a low-therapeutic level of anticoagulation. Patients with major or life-threatening bleeding, irrespective of their indication for anticoagulation (even patients with prosthetic metal heart valves) will usually require complete reversal of their anticoagulant therapy, at least temporarily. The peri-operative anticoagulant management of patients receiving warfarin is covered in detail here. The general principles are similar in each situation and all cases require an individualised risk:benefit assessment. Reversal of anticoagulant therapy may be necessary when a patient is found to be over-anticoagulated, develops bleeding problems or requires an invasive procedure. Reversal of Antithrombotic Therapies Introduction
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