Key result
Intravenous protamine sulfate administered for heparin reversal after coronary artery bypass grafting resulted in fatal anaphylactoid shock in a 73-year-old male with no known risk factors.
Case Report (n=1)
Highlights the risk of fatal anaphylactoid shock from protamine sulfate even in patients without known risk factors, emphasizing the need for alternative heparin reversal agents.
Fatal protamine reaction possible without known risk factors; hypothesis-generating for safer heparin reversal strategies in CABG.
A 73-year-old male underwent uneventful three-vessel coronary artery bypass grafting after which he received iv protamine sulfate for reversal of systemic heparinization. Shortly thereafter, the patient developed and succumbed to an anaphylactoid reaction attributed to protamine. The patient had none of the previously reported risk factors for hypersensitivity to the drug and was therefore not considered at high risk for such a severe adverse reaction. Although uncommon, the fatal outcome of this low-risk patient seriously addresses the need for alternative measures for heparin reversal.
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Shikuma et al. (1988) conducted a case report in Heparin reversal after coronary artery bypass grafting (n=1). Protamine sulfate was evaluated on Fatal anaphylactoid reaction. Intravenous protamine sulfate administered for heparin reversal after coronary artery bypass grafting resulted in fatal anaphylactoid shock in a 73-year-old male with no known risk factors.
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