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Heparin antagonist

Protamine sulfate

Adult dose

Dose: Heparin reversal: 1mg per 100 units heparin given in last 15 min (max 50mg). LMWH (within 8h): 1mg per 1mg enoxaparin (partial)
Route: IV slow
Frequency: single (titrate to APTT)

Clinical pearls

  • Reversal of unfractionated heparin (full); LMWH (partial); after CPB
  • Slow IV (≤5 mg/min) to minimise hypotension

Contraindications

  • Hypersensitivity to fish/protamine

Side effects

  • Hypotension
  • Bradycardia
  • Pulmonary hypertension
  • Anaphylaxis (esp. previous exposure, NPH insulin users, fish allergy)
  • Bleeding (if excess dose — paradoxical anticoagulant)

Interactions

  • Heparin (specific)

Monitoring

  • APTT
  • BP
  • HR

Reference: BNF; AAGBI; UK guidelines; https://bnf.nice.org.uk/drugs/protamine-sulfate/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.