protamine reaction
Pronunciation: PROH-tah-meen
Adverse reaction to protamine sulfate used to reverse heparin anticoagulation in cardiac surgery.
Full Definition
Protamine reaction refers to various adverse responses that can occur when protamine sulfate is administered to reverse heparin anticoagulation at the conclusion of cardiac surgery. Reactions range from mild hypotension to severe anaphylactoid responses including cardiovascular collapse, pulmonary hypertension, and bronchospasm. Risk factors include previous exposure to protamine, fish allergies, diabetes mellitus (due to protamine-containing insulin), and vasectomy. The reaction is thought to be mediated by complement activation, histamine release, and direct cardiovascular effects. Management includes immediate discontinuation of protamine, supportive care, and in severe cases, reinstitution of cardiopulmonary bypass. Alternative reversal strategies may be required in patients with known protamine sensitivity.
Usage
Usage note: Always specify severity and management when documenting protamine reactions.
In Context
- "A severe protamine reaction required immediate reinitiation of cardiopulmonary bypass and aggressive hemodynamic support." — critical incident report
- "Patients with diabetes should be questioned about insulin type due to increased risk of protamine reaction." — preoperative screening protocol