A prospective study of the risk of an immediate adverse reaction to protamine sulfate during cardiopulmonary bypass surgery.

@article{Weiler1990APS,
  title={A prospective study of the risk of an immediate adverse reaction to protamine sulfate during cardiopulmonary bypass surgery.},
  author={John M. Weiler and Marva Gellhaus and J Carter and R L Meng and Paul M. Benson and Rachel Hottel and K B Schillig and Arthur B. Vegh and William Clarke},
  journal={The Journal of allergy and clinical immunology},
  year={1990},
  volume={85 4},
  pages={
          713-9
        }
}

Protamine adverse reactions in NPH insulin treated diabetics undergoing coronary artery bypass grafting

TLDR
Examination of the relationship between neutral protamine Hagedorn (NPH) insulin use and severe adverse reactions to intravenous protamine given after cardiopulmonary bypass showed increased risk for hypotension among patients receiving N PH insulin for more than 5 years compared with those who were not exposed to NPH insulin.

Adverse Events After Protamine Administration Following Cardiopulmonary Bypass in Infants and Children

TLDR
There were no documented episodes of isolated or hypotension-associated right-sided cardiac failure or acute pulmonary dysfunction among 1249 anesthesia records, and cases of hypotension after protamine were more likely during operations on girls.

Mortality and Adverse Events After Protamine Administration in Patients Undergoing Cardiopulmonary Bypass

TLDR
Patients undergoing CPB who experience adverse events after a protamine administration have an increased risk of in-hospital mortality, and the odds ratio was largest when using the strictest definition for protamine-related events.

High incidence of antibodies to protamine and protamine/heparin complexes in patients undergoing cardiopulmonary bypass.

TLDR
These studies show that Abs to PRT/H occur commonly after cardiac bypass surgery, share a number of serologic features with HIT Abs, including platelet activation, and may pose health risks to patients requiring drug reexposure.

Does an allergy to fish pre-empt an adverse protamine reaction? A case report and a literature review

TLDR
A patient who had a known allergy to shellfish presented for first time cardiopulmonary bypass and the perfusion team were concerned that there was a realistic possibility that an adverse reaction to protamine could occur.

The toxicology of heparin reversal with protamine: past, present and future

TLDR
Unacceptable side effects of protamine have led to a search for new alternatives: UHRA, LMWP, and Dex40-GTMAC3 are in the preclinical stage; the two other agents (andexanet alfa and PER977) are already in the advanced clinical phases.

Serious anaphylactic reactions due to protamine sulfate: a systematic literature review.

TLDR
Overall, the findings support the low incidence of anaphylactic reactions reported in previous studies, but of note only few prospective investigations was conducted on the subject.
...

References

SHOWING 1-10 OF 38 REFERENCES

Serious adverse reactions to protamine sulfate: are alternatives needed?

Adverse reactions to protamine sulfate following cardiac surgery

TLDR
Four patients who developed severe adverse reactions to protamine sulfate following cardiac surgery have negative skin tests and no evidence of antibody mediated reaction, suggesting some other mechanisms may play a part.

Association of protamine IgE and IgG antibodies with life-threatening reactions to intravenous protamine.

TLDR
It is concluded that in protamine-insulin-dependent diabetics, the increased risk of serious reactions when intravenous protamine was given appeared to be caused largely by antibody-mediated mechanisms.

Increased risk of severe protamine reactions in NPH insulin-dependent diabetics undergoing cardiac catheterization.

TLDR
It is recommended that diabetics on NPH insulin and patients with allergies to fish undergo cardiac catheterization without the use of protamine or, when necessary, that protamine be administered cautiously in anticipation of a major adverse reaction.

Protamine-induced fatal anaphylaxis. Prevalence of antiprotamine immunoglobulin E antibody.

Hypertension associated with protamine sulfate administration.

TLDR
A case of protamine-associated hypertension in a 76-year-old Caucasian woman with chronic renal failure undergoing hemodialysis is reported, and it is concluded that this reaction occurred as a result of administering excess protamine sulfate, which then acted on platelets.

Shock due to protamine hypersensitivity.

Anaphylactic shock following protamine administration.

TLDR
It is suggested that caution is warranted when protamine is administered to patients who may have been sensitized by previous injections, this applies to diabetics, certain blood donors, and previous cardiac surgery patients.

Protamine: A Review of its Toxicity

  • J. Horrow
  • Medicine, Biology
    Anesthesia and analgesia
  • 1985
TLDR
Little evidence exists to conclude that protamine directly depresses contractility of the human heart, except perhaps in patients with less compliant ventricles, which are more dependent on preload to maintain stroke volume.