Intravenously struino slowly or drip under the control of blood coagulability.
When an overdose of heparin is injected at a rate of 1 ml (10 mg) of protamine sulfate solution for 2 minutes. If necessary, the injections are repeated at intervals of 15-30 minutes, the total dose is usually 5 ml (50 mg) of the solution.
The maximum dose is 150 mg / h.
In case of bleeding, the daily dose is 5-8 mg / kg; intravenously drip in 2 divided doses at intervals of 6 hours.
The dose of the drug depends on the method of administration of heparin. The calculated dose of the drug is dissolved in 300-500 ml of 0.9% sodium chloride solution.
With bolus injections of heparin, the dose of protamine sulfate decreases depending on the time elapsed from the administration of heparin, since the latter is continuously removed from the body.
| Time elapsed since injections of heparin | The dose of protamine sulfate in calculated per 100 ME heparin |
| 15-30 minutes | 1.2-1.3 mg |
| 30-60 minutes | 0.5-0.75 mg |
| Over 2 hours | 0.25-0.375 mg |
2. If heparin was injected intravenously, it is necessary to stop its infusion and introduce 25-30 mg of protamine sulfate.
3. With subcutaneous and intramuscular injections of heparin, the dose of protamine sulfate is 1.2-1.3 mg per 100 ME heparin.
The first 25-50 mg of protamine sulphate should be administered intravenously slowly, and the remaining dose - intravenously drip during 8-16 hours. Probably fractional administration of protamine sulfate, which requires control of activated partial thromboplastin time (APTT). For example, if administered subcutaneously 20000 ME heparin, after 2 hours there is a resorption of heparin, from complexes with protamine to 3333 ME heparin, in this regard, the next dose of protamine sulfate is 33 mg.
4. In the case of using extracorporeal circulation during surgery, the dose of protamine sulfate is 1.2-1.3 mg per 100 ME heparin.When determining the dose of protamine, it is necessary to take into account the route of administration of heparin.
The maximum duration of treatment is 3 days.
With hypergeparinemia associated with extracorporeal circulation, the dose of the drug can be increased; in these cases, the solution is administered dropwise. Protamine sulfate is used to neutralize low molecular weight heparins (LMWH), but it is not able to completely eliminate their antithrombotic activity: 1 mg of protamine sulfate neutralizes 100 units of anti-IIbut of activity and not more than 60% of anti-Xa activity of low molecular weight heparins. When choosing a dose of protamine sulfate, it is necessary to take into account the amount of introduced low-molecular heparin, the route of its administration, the pharmacokinetics of the drug used, and the time elapsed after the last injection of low-molecular heparin.
Introduce Protamine sulfate intravenously slowly (1 mg protamine sulfate per 100 anti-Xa ME recently introduced low-molecular-weight heparin) or as an infusion. 8 hours after intravenous drip of low molecular weight heparin, a half dose of protamine sulfate can be used, after 12 hours Protamine sulfate most likely not required.Long-term preservation of the effect of low molecular weight heparin, which continues to come from the subcutaneous tissue, makes it justified to infuse a calculated dose of protamine sulfate for several hours or to repeat half-dose administration with persistent bleeding.
Patients with renal and hepatic insufficiency
In patients with mild to moderate renal insufficiency (CK> 30 mL / min and <60 mL / min), no dose reduction is required, in patients with severe renal insufficiency (CK <30 mL / min), the dose should be reduced by 25% .
Use with caution in liver failure.
Elderly people
In elderly patients, dose adjustments are not required (except for patients with impaired renal function).
Use in Pediatrics
Safety and effectiveness of protamine sulfate in children have not been studied, so the drug is not used in this category of patients. There are no data on the use of the drug in children.