Effects of differing rates of protamine reversal of heparin anticoagulation

The Effect of Differing Rates and Injection Sites on the Amount of Protamine Delivered Before Detection of Hemodynamic Alterations in Dogs

“…For cardiovascular procedures, protamine is rarely used without heparin. Studies comparing differing rates of protamine administration have shown that hemodynamic effects occur with rapid or slow administration; however, rapid administration causes a more profound systemic hypotension and pulmonary hypertension 34,35 . Because the post‐protamine measurements in the present study were taken as soon as the criteria for a protamine reaction were met, the magnitude of the hemodynamic parameters are not shown.…”

“…The hemodynamic effect of protamine is a function of the rate and route of administration. In previous studies, hemodynamic effects of protamine have been evaluated by using either different rates or routes of administration 26–35 . Because an interaction between rate and route of protamine administration is likely to exist, it would be valuable to know if combining these 2 parameters would change the incidence of adverse effects and the dose of protamine that can be delivered.…”

“…In previous studies, hemodynamic effects of protamine have been evaluated by using either different rates or routes of administration. [26][27][28][29][30][31][32][33][34][35] Because an interaction between rate and route of protamine administration is likely to exist, it would be valuable to know if combining these 2 parameters would change the incidence of adverse effects and the dose of protamine that can be delivered. The increased sensitivity of the canine model to protamine may magnify the hemodynamic effect between the rates of injection and the sites of injection of protamine.…”

Safety of heparin reversal with protamin and immediate sheath removal after coronary angioplasty

“…The injection rate never exceeded 10 mg/min. Protamin injections can cause hypotension and pulmonary edema (17,18) and these reactions can be prevented by slow injection (18). Care is also necessary to prevent and treat allergy to protamin (19).…”

Monitoring and Reversal of Anticoagulation and Antiplatelets

“…Because protamine is derived from fish sperm, patients with allergic reactions to fish can be pretreated with corticosteroids or antihistamines. [35][36][37] LMWH (Enoxaparin) LMWH (3000-5000 Da) is produced by chemical or enzymatic depolymerization of UFH (weight ranges 3000-30,000 Da). 38 This change in molecular weight and size creates several important differences between UFH and LMWH.…”