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Bleeding is the leading sign and symptom of tinzaparin overdosage.
Should bleeding occur, Tinzaparin sodium (innohep) should be discontinued in dependence on the severity of the bleeding and the risk of thrombosis.
In case of severe bleeding tinzaparin may be neutralised by protamine. After subcutaneous administration of different dosages of tinzaparin the anti-IIa-activity was neutralised to up to 85% and the anti-Xa-activity was neutralised up to 60% (47-74%) by intravenous administration of protamine sulphate (1 mg per 100 anti-Xa-I.U. tinzaparin). Repeated doses of protamine or a continuous infusion may be necessary.
Note that protamine overdosage has an anticoagulant effect in itself and that protamine may cause anaphylactoid reactions.
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