Because fatal reactions, often resembling anaphylaxis, have been reported with protamine sulfate, it should be given only when resuscitation equipment and treatment of anaphylactic shock are readily available.Over the past decade, novel oral anticoagulants (NOACs) have become more commonly used for prevention of venous thromboembolism (VTE), and management of stroke risk in patients with atrial fibrillation (AF). Administration of protamine sulfate can cause severe hypotensive and anaphylactoid reactions. Particular care should be taken to avoid overdosage with protamine sulfate. Neutralization of enoxaparin by protamine Time Since LOVENOX DoseĪ 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. Attending physicians confronted with a potential overdosage of enoxaparin should always use their best clinical judgment in determining the appropriate dosing regimen of protamine to be administered. In the event that prompt reversal of the anticoagulant effects of enoxaparin is required at any time after LOVENOX dosing, the following table is provided as a guide for initial use of protamine. Anti-factor Xa activity is never completely neutralized (maximum about 60%). However, even with higher doses of protamine, the aPTT may remain prolonged to a greater extent than usually seen with unfractionated heparin.

This effect may be largely neutralized by slow intravenous injection of protamine sulfate. The anticoagulant effect of LOVENOX is inhibited by protamine.

In more serious cases, protamine should be administered. LOVENOX should be immediately discontinued, at least temporarily, in cases of significant excess dosage.

Accidental overdosage following administration of LOVENOX (enoxaparin) may lead to hemorrhagic complications.

Pradaxa reversal