Protamine

Pharmacology

  • Reverses Effects of Heparin

Adverse Effects

  • Hypotension (see Hypotension): common
  • Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS)
    • Epidemiology: occurs within minutes to 1-2 hrs after dosage
  • Anaphylaxis (see Anaphylaxis)
    • Epidemiology
      • In 50% of cases, there has been a prior exposure to protamine (either with protamine to reverse heparin or to protamine zinc insulin)
    • Diagnosis
      • Swan: increased PA pressures with normal PCWP
      • Skin Testing: confirms sensitivity to protamine
    • Clinical
      • Hypotension
      • Bronchospasm

Treatment

  • Avoid use of protamine -> may use alternative hexadimethrine instead
  • Vasoconstrictors: alpha agonists
  • Corticosteroids
  • Mechanical ventilation (as required) and other supportive care

References

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