4/6/2023 0 Comments Antidote for heparin overdose![]() Blood sample T 2, 15 min after protamine infusion, was collected: r value of TEG was now normal and the patient was admitted to the operating theatre. 20 min after blood sampling, based on the first results of TEG analysis while standard coagulation tests were still pending. A first dose of 50 mg protamine was slowly given i.v. Blood sample T 1 (Table 1) was obtained 3 h after discontinuation of heparin infusion: TEG with native blood showed heparin effect with prolonged r (reaction) time >240 min (normal 4–10 min). A head CT scan was immediately performed revealing an intracranial haematoma at the operation site and the patient was admitted to the intensive care unit before surgical revision. Rapidly thereafter, the patient exhibited right-sided hemiplegia and impaired consciousness (Glasgow Coma Scale 10/15). A blood sample was obtained for standard coagulation tests: results were obtained 60 min later and showed heparin concentration of 4.5 U ml −1 using an anti-Xa heparin assay ( T 0, Table 1). After 12 h of infusion, the patient presented with bleeding from different puncture sites and heparin infusion was stopped. continuous UFH at a dose of 50 000 U per 24 h after a bolus dose of 50 U kg −1. A resident in neurosurgery prescribed i.v. On the postoperative day 2, the patient exhibited chest pain, dyspnoea, and mild hypoxaemia related to subsegmental pulmonary embolism on a computed tomography (CT) scan. ![]() 1–3 Herein, we present a case in which thromboelastography (TEG) 4–6 was used to quickly restore normal coagulation immediately before an emergency procedure for intracranial haemorrhage in a context of heparin overdose.Ī 51-yr-old woman without any medical history except obesity was admitted for elective removal of an intracranial hemangiopericytoma. The required dose of protamine to neutralize unfractionated heparin (UFH) is difficult to predict and use of standard coagulation tests such as activated partial thromboplastin time (aPTT) to assess the effectiveness of reversal may delay surgery, compromising patient safety. Editor-Reversing heparin-induced anticoagulation quickly and effectively can be challenging in bleeding patients undergoing emergency surgery.
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