When treating a patient on UFH experiencing external bleeding, what is the most appropriate dose of protamine sulfate?

The appropriate dosing of protamine sulfate when treating a patient on unfractionated heparin (UFH) who is experiencing external bleeding is based on the amount of UFH given. The general recommendation for reversing UFH is to administer protamine sulfate in a dose that corresponds to the weight of UFH administered.

For UFH, the reversal is typically calculated using a dosing ratio of 1 mg of protamine sulfate to every 100 units of UFH that has been administered within the last 4-6 hours. However, due to the variable half-life of heparin and its effect on coagulation, the total protamine dosage may vary based on clinical circumstances, such as the patient’s renal function and the specifics of the bleeding incident.

The option providing 31.5 mg would align with the concept that it is a more individualized dose likely calculated based on the specific situation of the patient and the amount of UFH they have received. The choice of this dose could reflect a scenario where the cumulative UFH administration was calculated and required a specific amount of protamine to effectively neutralize its anticoagulant effects in a bleeding scenario.

Administering a proper dose ensures effective reversal of heparin’s effects while minimizing the risk of