Protamine Reaction in Cardiovascular Surgery

Abstract

Coronary artery bypass grafting is the most performed cardiac surgery throughout the world today. The United States alone performs over 200,00 of these procedures every year. Protamine sulfate is administered to neutralize heparin given during these cases. Known hemodynamic effects are associated with protamine and on rare occasions, true anaphylaxis. A 10.7% chance exists of a protamine reaction occurring after its administration and five different risk factors that increase that chance are an allergy to fish, use of NPH insulins, previous vasectomy, previous exposure to protamine, and rapid administration of protamine. Treatment includes fluid resuscitation, administration of vasopressors, intra-aortic balloon pump, and also methylene blue but this has not been studied. A heparin removal device as an alternative to protamine shows promise.