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Anticoagulation And ACS Practice Test

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What agent reverses unfractionated heparin?
Correct Answer:
Protamine sulfate
Explanation:
Reversing unfractionated heparin works by directly neutralizing the drug’s effect. Heparin works by boosting antithrombin, which blocks thrombin and factor Xa. Protamine sulfate is a positively charged protein that binds to the negatively charged heparin, forming a stable complex and stopping heparin’s anticoagulant action. Because of this direct neutralization, protamine sulfate is the standard reversal for unfractionated heparin. Vitamin K reverses warfarin by restoring production of vitamin K–dependent clotting factors, so it doesn’t affect heparin. Prothrombin complex concentrate is used mainly to reverse warfarin, not to neutralize heparin. Idarucizumab specifically reverses the direct thrombin inhibitor dabigatran, not heparin.

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