title: Intentional low-molecular-weight heparin overdose:  a case report and review.
abstract: The reversal of low-molecular-weight heparins, particularly at supratherapeutic levels, remains challenging. The paucity of literature available to guide the treatment of these patients makes their management difficult for primary care providers, surgeons, and subspecialists alike. We report the case of a 34-year-old woman, who intentionally overdosed on enoxaparin (Lovenox) in a suicide attempt. Her initial antifactor Xa activity level was 8.3 IU/ml, the highest level reported in the literature to date. She was initially managed conservatively, however, within 24 h of admission she developed evidence of acute blood loss. Protamine sulfate and three doses of recombinant activated factor VII (rFVIIa) were administered in an effort to control bleeding. We report the effects of these measures and review the literature to date. Our study is one of the first to graph in-vivo antifactor Xa activity levels and to suggest a drug half-life of approximately 25 h.
authors.affiliation: Department of Hematology and Medical Oncology, University of Florida, Gainesville, Florida 32610-0278, USA. michael.byrne@medicine.ufl.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Byrne
authors.forename: Marc
authors.initials: M
authors.lastname: Zumberg
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D001780:Blood Coagulation Tests; D062787:Drug Overdose / Q000523:psychology; D017984:Enoxaparin / Q000009:adverse effects*; D015942:Factor VIIa / Q000627:therapeutic use*; D015951:Factor Xa / Q000032:analysis; D005260:Female; D006207:Half-Life; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D011479:Protamines / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013406:Suicide, Attempted / Q000523:psychology; D054556:Venous Thromboembolism / Q000097:blood / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D011479:Protamines; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa; D015951:Factor Xa