IV: Initial: Protamine dosage is determined by the amount of heparin administered 1 mg of protamine neutralizes ~100 units of heparin administer by slow IV injection over ~10 minutes maximum single dose: 50 mg. For heparin rebound, may consider protamine 25 mg/hour continuous IV infusion for 6 hours following the initial dose ( Ref).įollowing SUBQ heparin injection: Note: May consider protamine to neutralize prophylactic SUBQ doses of heparin when aPTT is significantly prolonged and patient has clinically significant bleeding ( Ref). If patient is not bleeding, consider not administering protamine since risks may outweigh benefits ( Ref).Ĭardiac surgery patients: After cardiopulmonary bypass, repeat protamine doses of 25 to 50 mg may be given to reverse large doses of intraoperative heparin if activated clotting time (ACT) remains elevated or if heparin rebound is a concern maximum total dose: 3 mg/kg ( Ref). For example, a patient receiving heparin 1,250 units/hour will require ~30 mg of protamine to neutralize heparin ( Ref). If heparin was administered as a continuous IV infusion, calculate protamine dose based on heparin administered in the preceding 2 to 3 hours. For example, if 2 hours has elapsed since a heparin overdose, administer half of the calculated initial protamine dose ( Ref). Note: Because heparin concentration decreases rapidly after administration (half-life of heparin is ~60 to 90 minutes), adjust protamine dosage depending on duration of time since heparin administration. Infants, Children, and Adolescents: IV: 1 mg protamine for each 100 anti-Xa units of dalteparin if aPTT prolonged 2 to 4 hours after first dose (or if bleeding continues), consider additional dose of 0.5 mg for each 100 anti-Xa units of dalteparin ( Ref).įollowing IV heparin administration: IV: Initial: Protamine dosage is determined by the amount of heparin administered 1 mg of protamine neutralizes ~100 units of heparin administer by slow IV injection over ~10 minutes maximum single dose: 50 mg ( Ref) if aPTT remains elevated, may repeat 0.5 mg of protamine for every 100 units of heparin ( Ref). Infants, Children, and Adolescents: IV: Protamine dosage is determined by the most recent dosage and time of administration of enoxaparin ( Ref).Įnoxaparin dose administered ≤8 hours: IV: Dose of protamine should equal the dose of enoxaparin administered therefore, 1 mg protamine sulfate neutralizes 1 mg of enoxaparin ( Ref).Įnoxaparin administered >8 hours prior or if it has been determined that a 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 sulfate for every 1 mg enoxaparin ( Ref).ĭalteparin (subcutaneous) neutralization/reversal:
Protamine dosage is determined by the most recent dosage of LMWH ( Ref):Įnoxaparin (intravenous and subcutaneous) neutralization/reversal: Limited data available: Dosing extrapolated from experience in adult patients: Note: Protamine will not completely neutralize the anti-Xa activity (maximum: ~60% to 75%). Low molecular weight heparin (LMWH) neutralization/reversal (enoxaparin, dalteparin):
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