Anticoagulant Overdose 29
BUY
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Hematologic Disorders
Anticoagulant Overdose
Unfractionated Heparin Overdose:
1. Discontinue heparin infusion.
2. Protamine sulfate, 1 mg IV for every 100 units of heparin infused in
preceding hour, dilute in 25 mL fluid IV over 10 min (max 50 mg in 10 min
period). Watch for signs of anaphylaxis, especially if patient has been on
NPH insulin therapy.
Low Molecular Weight Heparin (Enoxaparin) Overdose:
-Protamine sulfate 1 mg IV for each 1 mg of enoxaparin given. Repeat
protamine 0.5 mg IV for each 1 mg of enoxaparin, if bleeding continues
after 2-4 hours. Measure factor Xa.
Warfarin (Coumadin) Overdose:
-Gastric lavage and activated charcoal if recent oral ingestion. Discontinue
Coumadin and heparin, and monitor hematocrit q2h.
Partial Reversal:
-Vitamin K (Phytonadione), 0.5-1.0 mg IV/SQ. Check INR in 24 hours, and
repeat vitamin K dose if INR remains elevated.
Minor Bleeds:
-Vitamin K (Phytonadione), 5-10 mg IV/SQ q12h, titrated to desired INR.
Serious Bleeds:
-Vitamin K (Phytonadione), 10-20 mg in 50-100 mL fluid IV over 30-60 min
(check INR q6h until corrected) AND
-Fresh frozen plasma 2-4 units x 1.
-Type and cross match for 2 units of PRBC, and transfuse wide open.
-Cryoprecipitate 10 U x 1 if fibrinogen is less than100 mg/dL.
Labs: CBC, platelets, PTT, INR.
Deep Venous Thrombosis
1. Admit to:
2. Diagnosis: Deep vein thrombosis
3. Condition:
4. Vital signs: q shift. Call physician if BP systolic >160, <90 diastolic, >90, <60;
P >120, <50; R>25, <10; T >38.5
C.
5. Activity: Bed rest with legs elevated.
6. Nursing: Guaiac stools, warm packs to leg prn; measure calf circumference
qd; no intramuscular injections.
7. Diet: Regular
8. IV Fluids: D5W at TKO
