🔵 1. Unfractionated Heparin (UFH) (IV heparin)

🚨 Major bleeding → Protamine

💊 Protamine dosing (max 50 mg):

• 0–30 min:
  → 1 mg per 100 units heparin

• 30–60 min:
  → 0.75 mg per 100 units

• 60–120 min:
  → 0.5 mg per 100 units

• >2 hrs:
  → 0.25–0.375 mg per 100 units

👉 Base dose on heparin given in last 2–3 hrs

⚠️ Administration

• Give slow IV over ≥10 min

• Max 50 mg per 10 min

• Avoid rapid push → hypotension/bradycardia

🔁 Redose

• If bleeding persists + ↑ aPTT →
  → 0.5 mg per 100 units after ~30 min

🔴 2. Low Molecular Weight Heparin (LMWH) (Enoxaparin, Dalteparin)

👉 Protamine = partial reversal (~60–75%)

🚨 When to use

• Only for major / clinically significant bleeding

💊 Enoxaparin reversal (max 50 mg):

• <8 hrs since dose:
  → 1 mg protamine per 1 mg enoxaparin

• 8–12 hrs:
  → 0.5 mg per 1 mg

• >12 hrs:
  → Usually not needed

🔁 Repeat dose

• If bleeding persists (2–4 hrs later):
  → 0.5 mg protamine per 1 mg enoxaparin

⚠️ Dalteparin

• 1 mg protamine per 100 units dalteparin

short version

🔵 UFH (IV heparin)

• Protamine (max 50 mg):

  • 0–30 min → 1 mg / 100 units

  • 30–60 min → 0.75 mg / 100 units

  • 60–120 min → 0.5 mg / 100 units

  • 2 hr → 0.25–0.375 mg / 100 units

• Give slow IV ≥10 min

• Redose if bleeding + ↑ aPTT

🔴 LMWH (enoxaparin, dalteparin)

• Partial reversal only (~60–75%)

• Enoxaparin:

  • <8 hr → 1 mg protamine / 1 mg enoxaparin

  • 8–12 hr → 0.5 mg / 1 mg

  • 12 hr → usually none

• Repeat dose:
  → 0.5 mg/kg if bleeding persists