Protamine

Aka: Protamine

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II. Indications

  1. Heparin Reversal
  2. Low Molecular Weight Heparin (LMWH) partial reversal

III. Mechanism

  1. Binds and neutralizes Heparin and partially binds and neutralizes Low Molecular Weight Heparin (LMWH)

IV. Dosing: Heparin Reversal (FDA Approved)

  1. General
    1. Base Protamine on Heparin dose within the last 2 hours
      1. Heparin has a short Half-Life of less than 90 minutes
    2. Deliver Protamine slowly (rate up to 50 mg per 10 minutes)
    3. May require additional or prolonged Protamine dosing for SQ Heparin reversal
  2. Last Heparin dose in last 30 minutes
    1. Protamine 1 mg per 100 units Heparin
  3. Last Heparin dose longer than 30 minutes ago
    1. Protamine 0.5 mg per 100 units Heparin

V. Dosing: Low Molecular Weight Heparin (LMWH) partial reversal (off-label use)

  1. Last LMWH dose in last 8 hours
    1. Protamine 1 mg per 100 anti-Xa units Dalteparin
    2. Protamine 1 mg per 1 mg Enoxaparin
  2. Last LMWH dose longer than 8 hours ago
    1. Protamine 0.5 mg per 100 anti-Xa units Dalteparin
    2. Protamine 0.5 mg per 1 mg Enoxaparin
  3. Additional dose if PTT still prolonged at 2-4 hours after Protamine infusion
    1. Protamine 0.5 mg per 100 anti-Xa units Dalteparin
    2. Protamine 0.5 mg per 1 mg Enoxaparin

VI. Adverse Effects

  1. Anaphylactoid Reaction with rapid administration (especially with fish allergy history)
    1. Pulmonary Edema
    2. Hypotension to the point of cardiovascular collapse

VII. Resources

  1. Protamine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e1964129-33f4-4e4e-86e3-8e6a4e65bd83
  2. Medscape
    1. http://reference.medscape.com/drug/protamine-343746
  3. Global RPH
    1. http://www.globalrph.com/protamine_dilution.htm

VIII. References

  1. (2010) Tarascon Pharmacopoeia

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