Note: Protamine will not completely neutralize the anti-Xa activity (maximum: ~60% to 75%). Low molecular weight heparin (LMWH) neutralization/reversal (enoxaparin, dalteparin): If given as a continuous IV infusion, only heparin given in the preceding 2 to 4 hours should be considered when administering protamine (ACCP Park 2021). Infants, Children, and Adolescents: IV: Note: Since heparin disappears rapidly from the circulation, the dose of protamine is adjusted based upon the time since heparin administration (see table). Note: 1 mg of protamine sulfate neutralizes ~100 units of heparin or 1 mg of enoxaparin (ACCP Park 2021). One report of a 10-fold enoxaparin overdose in a neonate (40 mg dose of enoxaparin administered) described using smaller protamine aliquots (10 mg) of the total protamine dose every 2 to 3 hours until the anti-Xa level was <2 units/mL to avoid potential protamine toxicity from administration of a large single dose (Wiernikowski 2007). IV: 0.25 to 0.375 mg of protamine per 100 units of heparin maximum dose: 50 mg/doseĮnoxaparin (intravenous or subcutaneous) neutralization/reversal: Limited data available dosing based on experience in adult patients (ACCP Park 2021): Note: Anti-Xa activity is never completely neutralized (maximum: ~60%).Įnoxaparin last administered in ≤8 hours: IV: Dose of protamine sulfate should equal the dose of enoxaparin administered therefore, 1 mg protamine neutralizes 1 mg enoxaparin (Lovenox prescribing information).Įnoxaparin last administered in >8 hours or if it has been determined that second dose of protamine is required (eg, if aPTT measured 2 to 4 hours after the first dose remains prolonged or if bleeding continues): IV: 0.5 mg protamine per 1 mg enoxaparin (Lovenox prescribing information).
IV: Note: Since heparin disappears rapidly from the circulation, the dose of protamine is adjusted based upon the time since heparin administration (see table). Heparin (intravenous) neutralization/reversal: Limited data available: Note: 1 mg of protamine sulfate neutralizes ~100 units of heparin or 1 mg of enoxaparin (ACCP ).
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