Korean J Anesthesiol.  2004 Dec;47(6):894-897. 10.4097/kjae.2004.47.6.894.

Heparin Anticoagulation and Natural Reversal in a Patient with Anaphylactoid Shock to Protamine: A case report

• Park SJ
• Lee BH
• Jee DL

• KMID: 2032610
• DOI: http://doi.org/10.4097/kjae.2004.47.6.894

Abstract

Protamine is the only agent approved to reverse heparin induced anticoagulation after cardiopulmonary bypass, although it may cause systemic hypotension, anaphylaxis or an anaphylactoid reaction, or pulmonary hypertension. However, there are no clinically available alternatives to protamine to neutralize systemic heparin in patients who are known to be allergic to protamine. We anesthetized a patient for mitral valve replacement who had previously an anaphylactoid shock to protamine. Because of the risk of an anaphylactoid shock, we allowed spontaneous reversal of heparin anticoagulation without the use of protamine after cardiopulmonary bypass and achieved a successful result. If a severe adverse reaction to protamine is suspected, it might be appropriate to allow the spontaneous reversal of heparin despite a greater risk of bleeding.

Keyword

anaphylactoid shock; cardiopulmonary bypass; heparin; protamine

MeSH Terms

Anaphylaxis
Cardiopulmonary Bypass
Hemorrhage
Heparin*
Humans
Hypertension, Pulmonary
Hypotension
Mitral Valve
Shock*
Heparin