Protamine dose for heparin or enoxaparin reversal
Protamine dose by anticoagulant, amount, and time since the last dose.
Inputs
0 of 3Anticoagulant
as chosen
For a drip, enter 0.
h
When to use
- Major bleeding or an urgent procedure on heparin or enoxaparin.
Pearls and pitfalls
- Give no faster than 5 mg/min to limit hypotension and anaphylactoid reactions.
- Protamine reverses only about 60% of enoxaparin's anti-Xa effect.
- Risk of reaction is higher with fish allergy, prior protamine, NPH insulin, or vasectomy.
Why use
Avoids the common error of reversing the whole day's heparin dose.
Heparin: 1 mg per 100 units still active (bolus decays; infusion counts last 2.5 h). Enoxaparin: 1 mg per 1 mg within 8 h, 0.5 mg per 1 mg after 8 h. Max 50 mg per dose.