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Evaluation of patients at risk for protamine reactions
J H Levy1, I M Schwieger, J R Zaidan
1Emory University School of Medicine, Division of Cardiothoracic Anesthesiology, Atlanta, Ga.
The Journal of Thoracic and Cardiovascular Surgery
|August 1, 1989
Summary
Patients with fish allergies, prior vasectomies, or neutral protamine Hagedorn insulin use do not face increased protamine reaction risks after cardiopulmonary bypass. These factors are not contraindications for protamine administration.
Area of Science:
- Cardiology
- Anesthesiology
- Immunology
Background:
- Protamine reactions post-cardiopulmonary bypass (CPB) are a concern.
- Prior sensitization from neutral protamine Hagedorn (NPH) insulin, fish allergy, or vasectomy has been hypothesized to increase protamine reaction risk.
Purpose of the Study:
- To prospectively and retrospectively evaluate the incidence of clinical protamine reactions in cardiac surgical patients with specific risk factors.
- To determine if NPH insulin use, fish allergy, or prior vasectomy are contraindications for protamine administration after CPB.
Main Methods:
- Prospective evaluation of cardiac surgical patients with prior vasectomies and fish allergies.
- Retrospective analysis of 3245 consecutive cardiac surgical patients undergoing CPB over two years.
- Assessment of protamine-containing insulin use and adverse reactions post-protamine administration for heparin reversal.
Main Results:
- No clinical reactions to protamine were observed in patients with fish allergies (n=6) or prior vasectomies (n=16).
- One reaction (0.6%) occurred in 160 patients using NPH insulin-dependent diabetes, which was not significantly different from the 0.06% incidence in other patients (2/3085).
Conclusions:
- Prior NPH insulin use, fish allergy history, or vasectomy are not contraindications for protamine administration.
- The study suggests that these factors do not significantly increase the risk of protamine reactions after CPB.