A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation is evaluated for vaginal bleeding. Five days ago, she was admitted to the hospital and started on treatment for a deep vein thrombosis in the right leg. Her pulse is 125/min and blood pressure is 95/67 mm Hg. Physical examination shows large hematomas on the upper limbs and swelling in the right calf. There is a large amount of bright red blood in the vaginal vault. Laboratory studies show a hemoglobin of 8.9 mg/dL, platelet count of 185,000/mm3, and activated partial thromboplastin time of 160 seconds. Which of the following is the most appropriate pharmacotherapy to rapidly reverse this patient's coagulopathy?

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Eductional Objective: Five days after starting treatment for deep vein thrombosis, this pregnant woman developed hemodynamic instability and anemia secondary to bleeding, which was likely caused by heparin overdose, as suggested by the prolonged aPTT. Protamine sulfate is the antidote for heparin overdose. Protamine is a cationic peptide that binds to heparin, forming a stable compound that has no anticoagulant activity. Protamine sulfate is more effective in reversing the effects of unfractionated heparin than low molecular weight heparin (LMWH) because protamine does not fully counter the anti-factor X effect of LMWH.

A 28-Year-Old Woman, Gravida 1, Para 0, at 32 Weeks