Evaluation of patients at risk for protamine reactions

Levy, Jerrold H.; Schwieger, Ian M.; Zaidan, James R.; Faraj, Bahjat A.; Weintraub, William S.

doi:10.1016/s0022-5223(19)34410-1

Cited by 119 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We reported an incidence of 0.6% (1 of 160) to 2% (1 of 50) in NPH insulin-dependent diabetics undergoing cardiac surgery, a rate 10£ to 30£ greater than other patients from a total of 4,796 patients evaluated. 16,17 However, the incidence in our general patient population was also 1 in 1,500, identical to what the authors report in their patients as well. 16,17 Protamine is known to cause acute pulmonary hypertension leading to acute right ventricular failure, also called catastrophic pulmonary vasoconstriction, as previously described, and is mediated by complement activation.…”

supporting

confidence: 91%

“…16,17 However, the incidence in our general patient population was also 1 in 1,500, identical to what the authors report in their patients as well. 16,17 Protamine is known to cause acute pulmonary hypertension leading to acute right ventricular failure, also called catastrophic pulmonary vasoconstriction, as previously described, and is mediated by complement activation. 15,18 However, multiple mechanisms can cause complement activation, including heparin-protamine interactions or by antiprotamine-IgG antibody interaction and C5a-mediated thromboxane release.…”

supporting

confidence: 91%

See 1 more Smart Citation

Protamine, is something fishy about it? The spectre of anaphylaxis continues

Levy

Bartz

2019

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

View full text Add to dashboard Cite

supporting

confidence: 91%

supporting

confidence: 91%

Protamine, is something fishy about it? The spectre of anaphylaxis continues

Levy

Bartz

2019

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

View full text Add to dashboard Cite

“…(6) showed that 27% of these subjects developed major allergic reactions during cardiac catheterization when heparin coagulation was reversed by intravenous protamine injection. Corresponding outcomes including life‐threatening reactions or even death were observed during cardiac and other surgeries (9–12).…”

Section: Discussionmentioning

confidence: 99%

IgE‐mediated allergy to recombinant human insulin in a diabetic

Baur

Bossert

Koops

2003

Allergy

View full text Add to dashboard Cite

A 63-year-old nonatopic female suffering from type II diabetes with severe local and systemic immediate-type allergic reactions to injections of different recombinant human insulin products has been reported. Skin testing as well as IgE measurements not only proved immediate-type sensitization to human insulin but also to porcine and bovine insulin which had never been administered and indicated immunological cross-reactivity. Cross-reactivity was proved by an IgE inhibition test. Independent of this reaction, the patient showed IgE-mediated sensitization to protamine.

show abstract

“…22 These findings contrasted to those patients without NPH exposure, occurring at a frequency of one in 1543 subjects. 23 Conversely, a case study looking at prior literature found that the incidence of reactions to protamine ranged from 0.06% to 10.7%. 7…”

Section: Complications Of Protamine In Cardiac Surgerymentioning

confidence: 99%

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Yasar

Bickel

Zhang

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Background The utility of protamine sulfate for heparin reversal in catheter‐based atrial fibrillation (AF) ablation is unclear when using the suture closure technique for vascular hemostasis. Objective This study sought to address if protamine sulfate use for heparin reversal reduces vascular access complications in AF catheter ablation when suture techniques are used for postprocedural vascular hemostasis. Methods This is a retrospective multicenter observational study of 294 consecutive patients who underwent catheter ablation for AF with subsequent vascular access hemostasis by means of a figure‐of‐eight suture or stopcock technique. A total of 156 patients received protamine for heparin reversal before sheath removal while 138 patients did not receive protamine. The two groups were compared for procedural activated clotting time (ACT), access site complications, and duration of hospital stay. Results Baseline demographic characteristics were comparable in both groups. Despite higher ACT before venous sheath removal in patients not receiving protamine (288.0 ± 44.3 vs 153.9 ± 32.0 seconds; P < .001), there was no significant difference in groin complications, postoperative thromboembolic events, or duration of hospital stay between the two groups. Suture failure requiring manual compression was rarely observed in this cohort (0.34%). Conclusion With modern vascular access and sheath management techniques, for patients undergoing catheter ablation for AF, simple suture closure techniques can obviate the need for protamine administration to safely achieve hemostasis after removal of vascular sheaths.

show abstract

Evaluation of patients at risk for protamine reactions

Cited by 119 publications

References 16 publications

Protamine, is something fishy about it? The spectre of anaphylaxis continues

Protamine, is something fishy about it? The spectre of anaphylaxis continues

IgE‐mediated allergy to recombinant human insulin in a diabetic

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Contact Info

Product

Resources

About