Guideline on the management of bleeding in patients on antithrombotic agents.

Guideline on the management of bleeding in patients on antithrombotic agents. Definitions for the quality of the evidence (A-C) and strength of recommendation (strong [grade 1], weak [grade 2]) are given at the end of the "Major Recommendations" field. Stopping an UFH infusion and general haemostatic measures are often sufficient to stop or prevent bleeding (2C). Protamine sulphate (1 mg per 80–100 units UFH) will fully reverse UFH, but should be given slower than 5 mg/min to minimize the risk of adverse reactions. The maximum recommended dose of 50 mg protamine is sufficient to reverse UHF in most settings. Low Molecular Weight Heparin (LMWH) LMWH administration within 8 hours of the time of requirement for correction of anticoagulation: give protamine sulphate (1 mg per 100 anti-Xa units of LMWH). If ineffective, consider further protamine sulphate 0.5 mg per 100 anti-Xa units (2C). Protamine sulphate should be given slower than 5 mg/min to minimize the risk of adverse reactions. LMWH administration greater than 8 hours from the time of requirement for correction of anticoagulation: consider smaller doses of protamine (2C). Consider recombinant activated factor VII (rFVIIa) if there is continued life-threatening bleeding despite protamine sulphate and the time frame suggests there is residual effect from the LMWH contributing to bleeding. (2C).