AC: Reversal Agents

Question 1

Protamine

Answer 1

Heparin Reversal

1 mg protamine : 100 units circulating heparin

Max 50 mg in 10-min period

Question 2

Protamine for LMWH

Answer 2

– 1 mg protamine : 1 mg enoxaparin (if enox. given < 8 hours ago)
– 0.5 mg protamine : 1 mg enoxaparin (if enox. given > 8 hours ago)

Question 3

Protamine AEs

Answer 3

– Dyspnea, wheezing, cyanosis
– Flushing, urticaria
– Chills
– Chest pain
– Nausea / vomiting
– Bradycardia, severe hypotension, anaphylactoid reactions have occurred from too rapid admin

Question 4

Vitamin K

Answer 4

Warfarin Reversal

PO preferred, IV for life-threatening bleeds

1. hold warfarin therapy
2. give one dose of Kcentra
   -INR 2-3.9: 25
   -INR 4-6: 35
   -INR > 6: 50
3. give IV Vitamin K 5-10 mg/50 mL NS, IV over 30 minutes
   * Vitamin K can be repeated every 12 hours*

Question 5

Idarucizumab (Praxbind)

Answer 5

Only for dabigatran reversal

2.5g/50mL IV bolus x2 (total dose=5g)

Question 6

Andexanet Alfa (AndexXa)

Answer 6

Only for rivaroxaban or apixaban

Low dose: R<10, A<5 (>8hr, <18hr)
-400 mg at 30 mg/min then 480 mg IV/2hr

High dose: opp
-800 mg at 30 mg/min then 960 mg IV/2hr

Question 7

Fresh Frozen Plasma (FFP)

Answer 7

10-20 mL/kg will increase factor levels by 20-30%

1-unit FFP = 200 mL