Association of Protamine IgE and IgG Antibodies with Life-Threatening Reactions to Intravenous Protamine

Abstract

Life-threatening reactions to intravenous protamine, administered to reverse heparin anticoagulation, have been reported with increasing frequency as a consequence of the escalating use of cardiac catheterization and coronary bypass surgery. Retrospective studies have shown that such reactions are more common in diabetic patients receiving daily subcutaneous injections of protamine–insulin preparations. To determine whether antiprotamine IgE or IgG antibodies might explain the increased risk for protamine reactions among patients with protamine–insulin–dependent diabetes, we conducted a case-control study of 27 patients (diabetic and nondiabetic) who had acute reactions to intravenous protamine and 43 diabetic patients who tolerated protamine without a reaction during diagnostic or surgical procedures. Cases and controls were grouped according to previous exposure to protamine–insulin preparations.