Bloody Minded Episode 75 - On the Wards: A Practical Guide to Anticoagulants | Part 1 (Basic Injectables)
Jan 20, 2026
Join haematologist Alison Chandler, a clinician-educator specializing in anticoagulation, as she unravels the mysteries of injectable anticoagulants. Discover why heparin can make your blood feel 'fat' and why the term 'blood thinners' is frowned upon. Alison explains unfractionated heparin’s mechanisms, monitoring challenges, and practical use on the wards. Plus, learn about low molecular weight heparin's advantages and dosing nuances in special populations, like during pregnancy. Get ready for a fascinating dive into the world of anticoagulation!
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Reverse Heparin Carefully With Protamine
- If you need to reverse unfractionated heparin for bleeding or surgery, stop the infusion and consider protamine.
- Give protamine slowly and calculate dose carefully to avoid anaphylactoid reaction and excess bleeding.
Protamine Dosing Mirrors Recent Heparin Dose
- Use the protamine dosing rule: 1 mg protamine neutralises ~100 units heparin and cap doses on the wards.
- Adjust dose by time since last heparin because heparin has a short half-life.
Watch Platelets And Act Fast For HIT
- Monitor platelets during heparin therapy and use the 4T score if platelets fall or thrombosis occurs to assess for HIT.
- If HIT is suspected, stop all heparins and switch to a non‑heparin anticoagulant while assessing for thrombosis.