Protamine
Mechanism :
It is a drug with weak anticoagulant effects. It combines with heparin, forming a salt and neutralizes anticoagulant the effect of both the drugs. It disrupts the heparin (as protamine is strongly a basic compound) antithrombin 3 complex thus preventing coagulation. It result in thromboplastin inhibitions causing decrease in thrombin activity.
Indication :
- For the reversal of low molecular weight heparin toxicity
- Hemorrhage associated with unfractionated heparin or LMWH therapy. (Heparin Neutralization)
Contraindications :
Fish hypersensitivity
Dosing :
For the reversal of low molecular weight
heparin toxicity:
The dose of protamine required is time dependent, if less than 30 minutes has passed since LMWH has been given then the dose is 1 mg/100 units of
heparin. If 30 to 60 minutes has passed administer 0.5 to 0.75 mg protamine/100 units of
heparin. If 60 to 120 minutes has passed administer 0.375 to 0.5 mg/100 units of
heparin. If more than 120 minutes has passed administer 0.25 to 0.375 mg/100 units of
heparin.
Adverse Effect :
Bradycardia ,serious hypersensitivity reactions or anaphylaxis ,pulmonary hypertension ,pulmonary edema ,anaphylactic shock ,angioedema ,bronchospasm ,heart failure ,hypotension ,dyspnea ,wheezing ,bleeding ,urticaria ,flushing ,back pain ,rash etc
Hepatic Dose :
No dose adjustment required