FAQs
Should Fresh Frozen Plasma Be Used to Reverse the Effects of Heparin?
Ummm...NO!
OK, so we have seen that FFP may be useful in correction of over-anticoagulation with warfarin. Well, what about using FFP for reversing the effects of heparin? First, remember that heparin works for anticoagulation by potentiating the effect of the anticoagulant antithrombin (aka, antithrombin III). Antithrombin strongly inhibits thrombin (surprise, surprise!) as well as factor X, as well as several other factors to a lesser extent. The key things to know about heparin are that it has an incredibly short half-life and that it is easily reversed by the medication protamine sulfate.
About once a year or so, I will get a call from the OR wanting to nail someone with a bunch of FFP because of an overload of heparin. Why would I have a problem with this? Well, for two reasons. First, heparin reverses so rapidly with protamine that it seems silly to give FFP that is going to take 20 minutes to thaw, in addition giving a patient exposure to a blood product unnecessarily. Secondly, but more important, is the fact that FFP stinks for reversing heparin! Think about this: Heparin works by potentiating antithrombin, right? You should know that up until the last few years when antithrombin concentrates became available, the product of choice for antithrombin deficiency was (you guessed it): FFP! So, we are going to try to reverse the effects of a drug by giving the patient the very thing that the drug works on? Doesn't make much sense to me, and I hope not to you, either.