Skip to main content

LMWH Antidote

Antidote:

  • Termination of the subcutaneous injection generally will terminate the anticoagulant effect.

  • If immediate reversal is required protamine sulfate will result in partial neutralization. If the LMWH 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 dose.

  • A second dose of 0.5 mg protamine / 1 mg 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 (vertebrate, not shellfish) and those who have received protamine-containing insulin or previous protamine therapy may be at risk of hypersensitivity reactions.

References

David, M., et al. (2007, Jan). Heparin and LMWH in Children. Thrombosis Interest Group of Canada. Retrieved Nov 15, 2018, from http://www.tigc.org/eguidelines/heparinchild07.htm.

Lexicomp Online, Pediatric and Neonatal Lexi-Drugs. Enoxaparin. Retrieved Nov 2018, from https:online.lexi.com.

Monagle, P., Chan, A. K. C., Goldenberg, N. A., Ichord, R. N., Journeycake, J. M., Nowak-Göttl, U., & Vesely, S. K. (2012). Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), e737S-e801S. https://doi.org/10.1378/chest.11-2308



Monagle, P., Cuello, C. A., Augustine, C., Bonduel, M., Brandão, L. R., Capman, T., Chan, A. K. C., Hanson, S., Male, C., Meerpohl, J., Newall, F., O'Brien, S. H., Raffini, L., van Ommen, H., Wiernikowski, J., Williams, S., Bhatt, M., Riva, J. J., Roldan, Y., . . . Vesely, S. K. (2018). American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2(22), 3292-3316. https://doi.org/10.1182/bloodadvances.2018024786



Roach, E. S., Golomb, M. R., Adams, R., Biller, J., Daniels, S., Deveber, G., Ferriero, D., Jones, B. V., Kirkham, F. J., Scott, R. M., & Smith, E. R. (2008). Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke, 39(9), 2644-2691. https://doi.org/10.1161/strokeaha.108.189696

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Evidence Based Practice Menu
Children's Mercy Kansas City   /    Health Care Providers   /    Evidence Based Practice / Clinical Pathways    /    Clinical Practice Guidelines, Care Process Models, and Enhanced Recovery After Surgery Pathways   /    Anticoagulation Therapies & VTE Risk Assessment   /   LMWH Antidote