Lovenox Reversal

– Discontinue Lovenox
– If significantly excessive dose given,  administer protamine
– aPTT remain prolonged to a greater extent than seen in UFH
– Anti-factor Xa never completely neutralized

Neutralization of enoxaparin by protamine
-Last dose given 8 hours and ≤ 12 hours=0.5 mg protamine per 1mg enoxaparin
– ≥ 12 hours=may not be required

A second infusion of 0.5 mg protamine per 1 mg LOVENOX may be administered if the aPTT measured 2 to 4 hours after the first infusion remains prolonged.

Watch out for:
severe hypotensive and anaphylactoid reactions

*LMWH reversal
[8h since last LMWH dose]
Dose: 0.5 mg IV per 100 anti-Xa units LMWH; Max: 50 mg/dose; rate 5 mg/min; Info: may repeat dose x1 if bleeding continues; protamine incompletely neutralizes LMWH effects; 1 mg enoxaparin = 100 anti-Xa units

ionically binds heparin, forming a stable complex which neutralizes anticoagulant effects


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