Allergy to protamine.
Review published in Clinical reviews in allergy (1991)
Abstract
Recent advances in medicine, such as cardiac catheterization, phoresis, dialysis, and cardiopulmonary bypass technology, have increased the need for heparin anticoagulation. To antagonize heparin's effect and prevent hemorrhagic complications after the procedure, protamine has likewise been used more frequently. With its increased use have come increased reports of adverse protamine reactions consisting of rash, urticaria, elevation of pulmonary artery pressure, systemic hypotension, and, at times, death. The elevation of pulmonary artery pressure, which appears to be a rather common occurrence in animals, may be an isolated finding without clinical consequences in humans. However, this pulmonary vasoconstriction may, when severe, lead to acute right-sided heart failure and systemic hypotension. Other protamine reactions involve a decrease in systemic vascular resistance and systemic hypotension without changes in pulmonary artery pressure. Causes of acute protamine reactions may involve the generation of anaphyatoxins and prostanoids either from protamine-heparin complexes or complement-fixing antiprotamine IgG antibodies, from inhibition of plasma Carboxypeptidase N, from crosslinking of cell-surface antiprotamine IgE on mast cells and basophils with subsequent mediator release, or from potentiation of IgE-mediated release of histamine through a polycationin-recognition site. Although we have come a long way in understanding the mechanisms by which protamine can cause its ill effects in humans, more work is clearly needed to define, in prospective studies, the incidence of and risk factors for protamine reactions in various patient groups, and to delineate more clearly which mechanisms are involved in each clinical type of acute protamine reaction. Hopefully, this will lead to strategies and protamine alternatives that will prevent or diminish, in frequency or severity, adverse protamine reactions. Alternatively, a clearer picture of the risk factors important for protamine reactions and the predictive value of diagnostic tests (e.g., protamine IgE antibody) can also minimize the clinical impact of this increasingly common adverse event.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Recent advances in medicine, such as cardiac catheterization, phoresis, dialysis, and cardiopulmonary bypass technology, have increased the need for heparin anticoagulation. To antagonize heparin's effect and prevent hemorrhagic complications after the procedure, protamine has likewise been used more frequently.
Por qué esto importa para la hirudoterapia
This review examined adverse reactions to protamine, the drug commonly used to reverse heparin anticoagulation after procedures such as cardiac catheterization, dialysis, and cardiopulmonary bypass. The review describes multiple mechanisms of protamine reactions—including complement-fixing antiprotamine IgG antibodies, IgE-mediated mast cell and basophil mediator release, anaphylatoxin generation, and pulmonary vasoconstriction—and notes the need for prospective studies to define incidence, risk factors, and protamine alternatives. This is indirectly relevant to ASH's domain because the clinical need for protamine alternatives intersects with interest in hirudin-class direct thrombin inhibitors, which do not require protamine reversal and thus may circumvent these adverse reaction risks. Caveat: The review does not discuss leeches, hirudotherapy, or hirudin; its relevance to ASH's domain is indirect, based only on the broader clinical context of anticoagulation management challenges.
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026