A 50-year-old man on ICU is receiving therapeutic enoxaparin for a pulmonary embolism. He requires emergency surgery. The last dose of enoxaparin 1.5 ...

Question

A 50-year-old man on ICU is receiving therapeutic enoxaparin for a pulmonary embolism. He requires emergency surgery. The last dose of enoxaparin 1.5 mg/kg was given 4 hours ago. Anti-Xa level is 0.9 IU/mL. What is the most appropriate reversal strategy?

Accepted Answer

IV protamine - but only approximately 60-80% of anti-Xa activity can be reversed

Answer

IV protamine sulphate - 1 mg per 1 mg of enoxaparin given in the last 8 hours

Answer

IV vitamin K 10 mg

Answer

Fresh frozen plasma 15 mL/kg

Answer

No reversal is possible - postpone surgery for 24 hours

uk-fficm MCQ (SBA): LMWH Reversal

A 50-year-old man on ICU is receiving therapeutic enoxaparin for a pulmonary embolism. He requires emergency surgery. The last dose of enoxaparin 1.5 mg/kg was given 4 hours ago. Anti-Xa level is 0.9 IU/mL. What is the most appropriate reversal strategy?