Pharmacology

• Reverses Effects of Heparin

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Adverse Effects

• Hypotension (see Hypotension): common
• Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS)
  • Epidemiology: occurs within minutes to 1-2 hrs after dosage
• Anaphylaxis (see Anaphylaxis)
  • Epidemiology
    • In 50% of cases, there has been a prior exposure to protamine (either with protamine to reverse heparin or to protamine zinc insulin)
  • Diagnosis
    • Swan: increased PA pressures with normal PCWP
    • Skin Testing: confirms sensitivity to protamine
  • Clinical
    • Hypotension
    • Bronchospasm

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Treatment

• Avoid use of protamine -> may use alternative hexadimethrine instead
• Vasoconstrictors: alpha agonists
• Corticosteroids
• Mechanical ventilation (as required) and other supportive care

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References

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