Management of the Over-anticoagulated Patient Case 3

A 28-year-old woman, 1 week post-partum is being treated for possible pulmonary embolus with 10,000 units of Dalteparin. Approximately 90 minutes after administration she has a major PV bleed with estimated losses of 2-3litres which are ongoing. She feels lousy, lightheaded, and her observations are as follows:

• HR 120 regular, BP 90/40, Resp rate 32, GCS 15
• Saturation 89% on air, and improves to 96% on 15 litres

Examination reveals normal breath and heart sounds, a flat JVP, ongoing PV loss, slightly tender supra-pubic area and cool peripheries.

Which of these initial management steps is not appropriate?

What is the reversal agent of choice for LMWH reversal?

You decide to give her Protamine sulphate as the APTT is150 (APTTr 5.0). Which of the following statements are true about protamine?