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Updated: Aug 10, 2025
11:17
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
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Massive intentional enoxaparin overdose managed with minimal protamine: A single case report.
Jonathan de Olano1,2, Mary Ann Howland3,4, Mark K Su5,6
1Grady Hospital, Atlanta, GA.
Summary
This case report details a massive enoxaparin overdose managed with observation and low-dose protamine sulfate. Minimal protamine sulfate was used, showing variable effects on activated partial thromboplastin time (aPTT).
Area of Science:
- Pharmacology
- Toxicology
- Emergency Medicine
Background:
- Acute enoxaparin overdose management is not standardized.
- Low-molecular-weight heparins (LMWHs) like enoxaparin are widely used anticoagulants.
- Massive LMWH overdoses are rare but pose significant clinical challenges.
Observation:
- A 25-year-old male self-administered 2,480 mg of enoxaparin.
- Protamine sulfate was administered in two low doses (25 mg and 50 mg) due to concerns of compartment syndrome and elevated aPTT.
- Activated partial thromboplastin time (aPTT) showed transient improvement after protamine administration but anti-factor Xa activity was unaffected.
Findings:
- Observation and minimal protamine sulfate were sufficient for managing massive enoxaparin overdose.
- Protamine sulfate demonstrated variable efficacy in reversing the anticoagulant effects.
- The patient did not require blood products or experience further complications.
Implications:
- This case suggests a potential role for observation and cautious protamine sulfate use in massive enoxaparin overdose.
- Further research is needed to establish optimal protamine sulfate dosing and efficacy for LMWH reversal.
- Clinical guidelines for managing acute enoxaparin overdose may need refinement.
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