Abstract
Clinical practice guidelines recommend protamine sulfate for reversal of enoxaparin
associated bleeds dependent on the time from last administration and dose of enoxaparin.
We present a case of a hemodynamically unstable patient with an enoxaparin induced
abdominal wall hematoma/hemorrhage and the previous enoxaparin administration 21.5 h
prior to presentation with a therapeutic anti-Xa assay (0.8 IU/mL) upon assessment
in the emergency department. Along with resuscitative efforts, an interdisciplinary
team collaborated to administer protamine sulfate 50 mg intravenous once (0.5 mg per
1 mg of enoxaparin) to reverse the therapeutic anticoagulation. Our case demonstrates
the importance of monitoring renal function and the potential for accumulation of
enoxaparin in patients with renal dysfunction leading to prolonged therapeutic anti-Xa
assays. With the availability of anti-Xa assays, future reversal recommendations of
enoxaparin associated bleeds using protamine sulfate should include the initial anti-Xa
assay as a guide for the dosing regimen.
Keywords
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References
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Article Info
Publication History
Published online: September 28, 2018
Accepted:
September 25,
2018
Received:
September 22,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
