Anti-factor Xa levels, however, are not readily available at most institutions. Peak plasma levels of LMWH are found 3–4 hours after administration, and the half-life of the drug is 4.5–7 hours. Plasma levels of LMWH can be monitored by measuring anti-factor Xa levels however, studies correlating large overdoses have not been performed. Both cases were treated with an approximate 1 to 1 ratio of protamine sulfate to LMWH (30 mg and 20 mg, respectively) and showed incomplete reversal of anticoagulation. Two reports of enoxaparin overdose have been described in the literature a neonate received a 10-fold overdose and a 64-year old man received an extra daily dose. Due to its safety profile, there has been little literature regarding management and treatment of overdoses. The dose should not exceed 50 mg, and should be administered via slow IV (over 10 minutes) push.Enoxaparin, a low molecular weight heparin (LMWH), is used for prophylaxis and treatment of venous and arterial thromboembolism. This drug should not be given when bleeding occurs without prior heparin use. Vasopressors and resuscitation equipment should be immediately available in case of a severe reaction to protamine. In patients with any of these risk factors, the risk to benefit of administration of this drug should be carefully considered. Allergy to fish, previous vasectomy, and severe left ventricular dysfunction and abnormal preoperative pulmonary hemodynamics also may be risk factors. Risk factors include high dose or overdose, rapid administration, repeated doses, previous administration of this drug, and current or previous use of protamine-containing drugs (NPH insulin, protamine zinc insulin, and certain beta-blockers). HYPERSENSITIVITY REACTIONS: This drug can cause severe hypotension, cardiovascular collapse, noncardiogenic pulmonary edema, catastrophic pulmonary vasoconstriction, and pulmonary hypertension.This may be done by administering a portion of the dose slowly IV, followed by the remaining portion as a continuous infusion over 8 to 16 hours. If heparin is administered by deep subcutaneous injection, use 1 to 1.5 mg of protamine per 100 units of heparin. If 120 minutes since last heparin dose: 0.25 to 0.375 mg of protamine will neutralize 100 units of heparin. Since blood heparin concentrations decrease rapidly after heparin administration, adjust the protamine dosage depending upon the duration of time since heparin administration as follows: Renal Dose Adjustmentsĭata not available Liver Dose Adjustments Protamine sulfate 1 mg IV neutralizes approximately 90 units of heparin activity derived from lung tissue or about 115 units derived from intestinal mucosa. Usual Pediatric Dose for Heparin Overdose Usual Geriatric Dose for Heparin Overdose
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