This is in accordance with the limited published data concerning cases of overdose with other LMWHs. Bryant Management of Large Intentional Overdose of Enoxaparin with Protamine Sulfate. The favorable clinical outcome suggests that, regardless of the LMWH amount injected, no active treatment is needed in the absence of hemorrhage. Enoxaparin, a low molecular weight heparin (LMWH), is used for prophylaxis and treatment of venous and arterial thromboemb.
In this case of massive tinzaparin overdose, conventional doses of protamine failed to rapidly normalize the deranged coagulation parameters. Let’s review one of the most common causes of drug poisoning acetaminophen overdose which causes 400 deaths in the United States each year due to fulminant hepatic failure. No hemorrhagic complications occurred during her hospitalization except for prolonged bleeding from venipuncture sites. Normalization of the APTT occurred 40-50 h post admission, reflecting normal tinzaparin clearance rather than neutralization by protamine. She was given an intravenous infusion of 100 mg protamine sulfate and was admitted to the intensive care unit, where further infusions of protamine were administered. Despite an unrecordable activated partial thromboplastin time (APTT > 180 s) and prolonged prothrombin time, there was no evidence of active bleeding. To describe a case of self-poisoning with a very large dose of tinzaparin and discuss management options in patients with LMWH overdose.Ī 69-year-old woman was brought to the Emergency Department 2 h after injecting herself with 280,000 IU of tinzaparin subcutaneously in an attempt to commit suicide. The required dose of protamine to neutralize unfractionated heparin (UFH) is difficult to predict and use of standard coagulation tests such as activated partial thromboplastin time (aPTT) to assess the effectiveness of reversal may delay surgery, compromising patient safety. Recent reports of LMWH overdose illustrate the need for a consensus on its management. Despite the fact that its therapeutic use is considered to be safe, it can be complicated by major hemorrhage and, in contrast to unfractionated heparin, it can only partially be neutralized by protamine. Low-molecular-weight heparin (LMWH) is increasingly being prescribed for prophylaxis and treatment of thromboembolic diseases.