Unfractionated Heparin Overdose:
1. Discontinue heparin infusion.
2. Protamine sulfate, 1 mg IV for every 100 units of heparin infused in preceding
hour, dilute in 25 mL fluid IV over 10 min (max 50 mg in 10 min period).
Low Molecular Weight Heparin (Enoxaparin) Overdose:
-Protamine sulfate 1 mg IV for each 1 mg of enoxaparin given.
Repeat protamine 0.5 mg IV for each 1 mg of enoxaparin, if bleeding continues
after 2-4 hours. Measure factor Xa.
Warfarin (Coumadin) Overdose:
-Gastric lavage and activated charcoal if recent oral ingestion.
Discontinue Coumadin and heparin,and monitor hematocrit q2h.
Partial Reversal:
-Vitamin K (Phytonadione), 0.5-1.0 mg IV/SQ. Check INR in 24 hours,
and repeat vitamin K dose if INR remains elevated.
Minor Bleeds:
-Vitamin K (Phytonadione), 5-10 mg IV/SQ q12h, titrated to desired INR.
Serious Bleeds:
-Vitamin K (Phytonadione), 10-20 mg in 50-100 mL fluid IV over 30-60 min
(check INR q6h until corrected) AND
-Fresh frozen plasma 2-4 units x 1.
-Type and cross match for 2 units of PRBC, and transfuse wide open.
-Cryoprecipitate 10 U x 1 if fibrinogen is less than100mg/dL.
Labs: CBC, platelets, PTT, INR.
