Symptoms and Signs: Haemorrhage is the major clinical sign of subcutaneous or intravenous overdosage. The platelet count and other coagulation parameters should be measured. Minor bleeding rarely requires specific therapy, and reducing or delaying subsequent doses of nadroparin is usually sufficient.
Treatment: The use of protamine sulphate should be considered only in serious cases. It largely neutralises the anticoagulant effect of nadroparin but some anti-Xa activity will remain.
0.6 ml of protamine sulphate neutralises about 950 IU anti-Xa nadroparin. The amount of protamine to be injected, should take into account time elapsed from the injection of heparin, and a dose reduction of protamine may be appropriate.