Fatal anaphylactoid response to protamine after percutaneous transluminal coronary angioplasty

P P Neidhart1, B Meier, B S Polla

  • 1Department of Anaesthesia, University Hospital of Geneva, Switzerland.

A generalized skin erythema and severe hypotension developed following administration of protamine for the reversal of heparin anticoagulation after an unsuccessful attempt at percutaneous transluminal angioplasty in a patient who had never been exposed to protamines before. Evidence of classical pathway complement activation was present indicating that this reaction could have been triggered by a non-immunological mechanism. The patient could not adequately be resuscitated because of the presence of severe coronary artery disease.

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