Rectus Sheath Hematoma Medication

Updated: Dec 29, 2020
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.


Anticoagulation reversal agents

Class Summary

Patients on warfarin can have their anticoagulation reversed with phytonadione.

Phytonadione (Mephyton, Konakion, AquaMEPHYTON)

Vitamin K is a necessary cofactor for gamma carboxylation in the synthesis of factors II, VII, IX, and X in the liver. Used therapeutically in RSH to treat warfarin-induced hypoprothrombinemia.


Protamine forms a complex with heparin to create a nonreactive salt. Heparin is neutralized within 5 min of protamine administration. The duration of effect is 2 h. The half-life of protamine is less than heparin; therefore, multiple dosing may be required. LMWHs can be partially reversed with protamine.

The half-life of heparin is 60 min. Therefore, enough protamine should be administered to reverse all of the heparin administered in the last 30 min, one half of the heparin administered the previous hour, and one fourth of the heparin administered the hour before that, assuming no recent bolus.



Class Summary

RSHs are very painful conditions that often mimic or present as an acute abdomen. The clinician should have a low threshold for narcotic analgesia. The clinician should also recognize the theoretic complication of platelet inhibition with nonsteroidal anti-inflammatory analgesics.

Hydrocodone and acetaminophen (Lorcet-HD, Vicodin, Lortab)

Drug combination indicated for moderate to severe pain.

Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)

Drug combination indicated for the relief of moderate to severe pain.