UMEM Educational Pearls

Category: Toxicology

Title: Protamine for enoxaparin

Keywords: protamine, enoxaparin, Xa (PubMed Search)

Posted: 4/5/2012 by Ellen Lemkin, MD, PharmD
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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