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Protamine sulfate and fatal anaphylactoid shock
L R Shikuma1, S D Eyer, D E Zaske
1Critical Care/Pharmacokinetics, University of Minnesota College of Pharmacy, St. Paul-Ramsey Medical Center.
Drug Intelligence & Clinical Pharmacy
|March 1, 1988
Summary
A patient experienced a fatal anaphylactoid reaction to protamine sulfate after coronary artery bypass grafting. This rare event in a low-risk individual highlights the need for alternative heparin reversal methods.
Area of Science:
- Anesthesiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Protamine sulfate is commonly used to reverse heparin anticoagulation after cardiac surgery.
- Anaphylactoid reactions to protamine, though rare, can be severe and life-threatening.
- Identifying risk factors for protamine hypersensitivity is crucial for patient safety.
Observation:
- A 73-year-old male, with no known risk factors for hypersensitivity, received intravenous protamine sulfate post-coronary artery bypass grafting.
- The patient rapidly developed a fatal anaphylactoid reaction attributed to protamine sulfate.
- This outcome occurred despite the patient not being considered high-risk for such an adverse event.
Findings:
- Protamine sulfate administration can lead to fatal anaphylactoid reactions even in patients without established risk factors.
- The absence of prior risk factors does not preclude severe hypersensitivity to protamine.
- This case underscores the unpredictable nature of protamine hypersensitivity.
Implications:
- There is an urgent need to explore and develop alternative agents for heparin reversal in cardiovascular surgery.
- Clinicians should maintain a high index of suspicion for protamine reactions, regardless of patient history.
- Enhanced vigilance and preparedness for managing anaphylactoid reactions to protamine are essential.