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Protamine for enoxaparin overdose

Protamine for enoxaparin overdose

  • Protamine may be used to treat severe cases of hemorrhage in enoxaparin overdose
  • Protamine reverses the prolonged aPTT, but fails to completely reverse the anti-Xa effect (reverses about 60%)
  • Administer protamine by slow IV to equal the dose of enoxaparin injected: (1:1 ratio)
  • if < 8 hours after last dose enoxaparin, give 1 mg protamine per 1 mg enoxaparin;
  • if 8-12 hours after last dose enoxaparin, give 0.5 mg protamine per 1 mg enoxaparin;
  • if >12 hours after last dose of enoxaparin, protamine is not required
Ellen Lemkin,University of Maryland Emergency department
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