Protamine

Question 1

Protamine class

Answer 1

Heparin Antagonist

Question 2

Protamine MOA

Answer 2

Inhibits platelets and serine proteases involved in coagulation. Prolongs activated clotting time

Combines w/ heparin to form a complex that is devoid of anticoagulant activity

Question 3

Protamine dosage

Answer 3

50 mg common dose

5-15 mg for heparin rebound

1mg for every 100 units of heparin over 10 min

Question 4

Protamine characteristics

Answer 4

O: w/in 5 min

P:N/A

D: 2 hrs

Question 5

Protamine E/M

Answer 5

Clearance by reticuloendothelial system (w/in 20 min) is more rapid than heparin clearance which can explain heparin rebound phenomenon

Question 6

Protamine considerations

Answer 6

It is the only available agent to reverse unfractionated heparin. It does NOT reverse low-molecular weight heparin

Can cause heparin rebound 2-3 hrs after first dose

Can cause anaphylaxis, acute pulmonary vasoconstriction, R ventricular failure, & hypotension

Caution in pts with sensitivity to fish. Can pretreat hypersensitivity w/ corticosteroid or antihistamine

Monitor aPTTT at least 5-15 min p adm