In several studies, the risk of major bleeding from anticoagulant dose of LMWH medications was shown to be 0.5-4% within therapeutic dosage (4-6). Their anticoagulant effect creates the potential for b leeding (3). These medications are given as subcutaneous injection and contrary to unfractionated heparin, do not require laboratory monitoring, thereby they are allowed for self-administration and outpatient use (1,2). L ow molecular weight heparin (LMWH) is a class of medications which has been used for treatment and prevention of several disorders including deep vein thrombosis, pulmonary embolism, unstable angina and myocardial infarction. The use of protamine in LMWH overdose seems to remain controversial. This study suggests that a large dosage of LMWH is unlikely to result in any life threatening complications, though further studies are needed to certainly conclude about this. Conclusion: Most patients had no complications and were not treated with protamine. The 2 patients who received protamine were overdosed with more than 2.5 times the therapeutic dose of enoxaparin. Reassurance was given to patients with less than 0.14 times the therapeutic dose. No patients were documented to experience bleeding or have thrombocytopenia although complete follow-up was only available for 11 patients. The overdose ranged from 50 mg to 1300mg (0.1-80 times the therapeutic range). 7 cases were documented to have overdosed more than 2 times the therapeutic dose. The reasons for overdose included medical miscalculation (3 cases, all infants), intentional misuse (2 patients), accidental overdose (7 cases), suicidal attempt (7 cases) and unknown in 2 patients. Results: In total, 21 patients who were all exposed to enoxaparin were studied. All patients with a definite reported overdose of subcutaneous injection of LMWH were included. Methods: A retrospective chart review of California Poison Control System (CPCS) database: Visual Dot Lab during 1997 to 2007 was obtained. In this study, clinical profile, treatment and outcome of 21 patients who acutely overdosed enoxaparin are described. Currently there are few reports in the literature on acute overdose on adults. Few patients receiving therapeutic doses of LMWH develop major hemorrhage. Background: Low molecular weight heparin (LMWH) is used for the treatment and prevention of coagulative disorders.
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