Protamine for enoxaparin overdose

• Protamine may be used to treat severe cases of hemorrhage in enoxaparin overdose
• Protamine reverses the prolonged aPTT, but fails to completely reverse the anti-Xa effect (reverses about 60%)
• Administer protamine by slow IV to equal the dose of enoxaparin injected: (1:1 ratio) 
• if < 8 hours after last dose enoxaparin, give 1 mg protamine per 1 mg enoxaparin;
• if 8-12 hours after last dose enoxaparin, give 0.5 mg protamine per 1 mg enoxaparin;
• if >12 hours after last dose of enoxaparin,  protamine is not required