Enoxaparin reversal is determined based on the following table: 1. Dalteparin reversal is determined based on the following table: 2. Regardless of the heparin or LMWH dosage, the maximum recommended protamine dose is 50 mg. Hypersensitivity reactions to protamine sulfate have been discovered in patients who are allergic or have sensitivities to fish and other protamine containing medications such as NPH insulin.
Anaphylactoid reactions, hypotension, flushing, and pulmonary edema are more likely with larger doses or rapid administration. Additionally, men who have a history of vasectomies may also be at increased risk for these reactions, although newer evidence suggests that may not be true.
He went on to complete a two year Pharmacotherapy Residency with an emphasis in cardiology and critical care at the Cleveland Clinic in Cleveland, Ohio. Kantorovich is a Board Certified Pharmacotherapy Specialist. Show AMA citation. Heparin - Infusion Reversal of a continuous IV infusion of unfractionated heparin. Anticoagulant Details Heparin bolus dose units Time since bolus minutes hours. Press 'Calculate' to view calculation results. Load an Example. Lovenox [package insert].
Sanofi-Aventis U. October Fragmin [package insert]. Pfizer Inc. August American Society of Hematology. Caravati EM. Protamine sulfate. Medical Toxicology. Dart RC, ed. Pai M, Crowther MA. Neutralization of heparin activity. Handb Exp Pharmacol.
PMID Protamine [package insert]. Initially by intravenous injection. By intravenous injection, or by continuous intravenous infusion. Excessive doses can have an anticoagulant effect. Pulmonary oedema non-cardiogenic. Acute pulmonary vasoconstriction ; back pain ; bradycardia ; circulatory collapse ; dyspnoea ; fatigue ; feeling hot ; flushing ; hypertension ; hypotension ; nausea ; pulmonary hypertension ; vomiting. Caution if increased risk of allergic reaction to protamine includes previous treatment with protamine or protamine insulin, allergy to fish, men who are infertile or who have had a vasectomy and who may have antibodies to protamine.
The long half-life of low molecular weight heparins should be taken into consideration when determining the dose of protamine sulfate; the effects of low molecular weight heparins can persist for up to 24 hours after administration.
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