Protamine

• Mechanism of action
  • Binds to heparin to form a stable, inactive complex
  • Neutralises unfractionated heparin (UFH) completely
  • Partially neutralises low molecular weight heparin (LMWH)
• Dosage
  • 1 mg protamine neutralises ~100 units of UFH
  • Adjust dose based on:
    • Time since last heparin dose
    • Estimated circulating heparin
  • For LMWH: ~1 mg per 1 mg enoxaparin (partial reversal)
• Administration
  • Slow IV infusion over 10 minutes
  • Max rate: 50 mg over 10 min (rapid infusion ↑ risk of adverse effects)