AC: Reversal Agents Flashcards
Protamine
Heparin Reversal
1 mg protamine : 100 units circulating heparin
Max 50 mg in 10-min period
Protamine for LMWH
– 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)
Protamine AEs
– Dyspnea, wheezing, cyanosis
– Flushing, urticaria
– Chills
– Chest pain
– Nausea / vomiting
– Bradycardia, severe hypotension, anaphylactoid reactions have occurred from too rapid admin
Vitamin K
Warfarin Reversal
PO preferred, IV for life-threatening bleeds
- hold warfarin therapy
- give one dose of Kcentra
-INR 2-3.9: 25
-INR 4-6: 35
-INR > 6: 50 - give IV Vitamin K 5-10 mg/50 mL NS, IV over 30 minutes
* Vitamin K can be repeated every 12 hours*
Idarucizumab (Praxbind)
Only for dabigatran reversal
2.5g/50mL IV bolus x2 (total dose=5g)
Andexanet Alfa (AndexXa)
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
Fresh Frozen Plasma (FFP)
10-20 mL/kg will increase factor levels by 20-30%
1-unit FFP = 200 mL