Termination of the SQ injection generally will terminate the anticoagulant effect.
If immediate reversal is required protamine sulfate will result in partial neutralization. If the LMW heparin dose has been given within 3-4 hours give 1 mg protamine/1 mg of enoxaparin dose. If initiating treatment more than 4 hours after last dose given, give 0.5 mg protamine/1 mg of enoxaparin.
A second dose of 0.5 mgprotamine /1mg of enoxaparin dose may be given if the PTT remains prolonged 2-4 hours after the initial dose.
Protamine should be given IV over 10 minutes. More rapid infusion may result in hypotension. Patients with hypersensitivity to fish (vertibrate, not shellfish) and those who have received protamine-containing insulin or previous protamine therapy may be at risk of hypersensitivity reactions.
David, M., et al. Heparin and LMWH in Children. Thrombosis Interest Group of Canada. January 2007. http://www.tigc.org/eguidelines/heparinchild07.htm. Accessed 11/15/08.
Lexi-Drugs Online/Pediatric Lexi-Drugs Online, Enoxaparin, http://online.lexi.com/crlsql/servlet/crlonline, Copyright © 1978-2008 Lexi-Comp, Inc, Hudson, OH 44236
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