It is not appropriate for pediatric patients or for an operating room setting such as cardiovascular surgery. This calculator determines a neutralizing dose of protamine to reverse both UFH and LMWH in the non-surgical setting based on the anticoagulant to be reversed, the anticoagulant dose, and the time that the anticoagulant was last given.
The Reversing Hour
One milligram mg of protamine sulfate will neutralize approximately units of UFH. As more time elapses from heparin administration, less protamine is necessary to reverse the anticoagulant effects. Administration of full dose protamine is indicated in patients who need reversal less than 60 minutes after bolus administration. For patients on heparin infusions, due to the half-life of heparin, the amount of heparin administered over the previous 2 hours should be utilized to calculate a protamine dose.
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The half-life of protamine, about 7 minutes, is significantly shorter than UFH. In patients with elevated aPTTs as a result of heparin after protamine administration, a second dose of protamine may be considered.
Taking that into consideration, if reversal is necessary within 8 hours of receiving a LMWH, a full dose of protamine should be administered. In patients with elevated LMWH anti-Xa assays 2 to 4 hours after protamine administration, a second dose of protamine to achieve complete reversal may be considered.
For both enoxaparin and dalteparin, protamine does not provide a complete reversal of anti-Xa activity. Enoxaparin reversal is determined based on the following table: 1.
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Dalteparin reversal is determined based on the following table: 2. Regardless of the heparin or LMWH dosage, the maximum recommended protamine dose is 50 mg. Hypersensitivity reactions to protamine sulfate have been discovered in patients who are allergic or have sensitivities to fish and other protamine containing medications such as NPH insulin.
Anaphylactoid reactions, hypotension, flushing, and pulmonary edema are more likely with larger doses or rapid administration. Additionally, men who have a history of vasectomies may also be at increased risk for these reactions, although newer evidence suggests that may not be true. He went on to complete a two year Pharmacotherapy Residency with an emphasis in cardiology and critical care at the Cleveland Clinic in Cleveland, Ohio.
Kantorovich is a Board Certified Pharmacotherapy Specialist. See Subscription Options.see
Ornish Lifestyle Program | North Bay Cardiac Rehab
Jonathan O'Callaghan Jonathan O'Callaghan is a freelance journalist covering commercial spaceflight, space exploration, astrophysics, and a wide range of science. Get smart. Sign up for our email newsletter. Sign Up. See Subscription Options Already a subscriber? Each specialty provides individual coaching to modify lifestyle and promote the reversal of heart disease. Nutrition is a whole-food, plant-based diet.
Any one of the below conditions often qualify for reimbursement from Medicare and other commercial insurance providers:.
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Information related to your stay at MarinHealth Medical Center. In our closely knit groups, our experienced staff teaches our patients: How to prepare a whole-food, plant-based diet How to exercise Techniques such as yoga and meditation to help manage stress Methods of communication through group discussions What Are the Benefits of the Lifestyle? Who Qualifies for the Program?
Any one of the below conditions often qualify for reimbursement from Medicare and other commercial insurance providers: Current stable angina pectoris chest pain Acute myocardial infarction within the last 12 months heart attack Coronary artery bypass surgery Heart valve repair or replacement Percutaneous transluminal coronary angioplasty balloon or coronary stenting Heart or heart-lung transplant Other cardiac conditions as specified through a national coverage determination A 50 percent cash pay discount is also available for those who qualify, including: Patients who have completed our traditional Cardiac Rehabilitation Phase II program and would like to participate in a more in-depth, heart reversal program.
People who have multiple risk factors for a cardiac event and are seeking a heart reversal program. People seeking a program for primary prevention of a cardiac event due to a family history of heart disease.
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