The Challenge of Hemorrhagic Shock Management During Low-Molecular-Weight Heparin Treatment.

The reversal of low-molecular-weight heparin (LMWH) and the management of bleeding patients on LMWH remain highly challenging. Even if LMWH is very extensively administered in the prophylaxis and treatment of venous thrombosis, specific antidotes are lacking, and reversal strategies have very weak grade of evidences on clinical effectiveness. We here describe a reversal strategy with protamine and FVIIa in a patient presenting with hemorrhagic shock and cardiocirculatory arrest.