LMWH Reversal

Protamine Sulfate Administration Parameters

  • Administer by slow IV injection not to exceed 5 mg/min

  • Total dose not to exceed 50 mg

  • Monitor for anaphylaxis

  • Protamine only reverses ~60% of LMWH activity

LMWH given within past 8 hours

  • 1 mg Protamine Sulfate for every 1 mg of enoxaparin received

  • Additional 0.5 mg Protamine per 1 mg enoxaparin can be given after 30 minutes if clinical condition warrants

LMWH given > 8 hours ago

  • 0.5 mg Protamine Sulfate for every 1 mg of enoxaparin received

  • Additional 0.25 mg Protamine per 1 mg enoxaparin can be given after 30 minutes if clinical condition warrants