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  • ^Welsby, IJ; Newman, MF; Phillips-Bute, B; Messier, RH; Kakkis, ED. (2005). «Hemodynamic changes after protamine istration: association with mortality after coronary artery bypass surgery». Anesthesiology. 102 (2): 308–314. doi:10.1097/00000542-200502000-00011. PMID 15681944.
  • ^Walker, WS; Reid, KG; Hider, CF; Davidson, IA; Boulton, FE. (1984). «Successful cardiopulmonary bypass in diabetics with anaphylactoid reactions to protamine». Br Heart J.

    52 (1): 112–114. doi:10.1136/hrt.52.1.112. PMC 481594. PMID 6743419.

  • ^World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  • ^Sorgi, FL; Bhattacharya, S; Huang, L (Sep 1997).

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    «Protamine sulfate enhances lipid-mediated gene transfer». Gene Therapy. 4 (9): 961–8. doi:10.1038/ PMID 9349433.

  • ^ ab«Protamine sulfate». Retrieved 14 February 2019.
  • ^ abcCampbell, FW; Goldstein, MF; Atkins, PC. (1984). «Management of the patient with protamine hypersensitivity for cardiac surgery».

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    Anesthesiology. 61 (6): 761–764. doi:10.1097/00000542-198412000-00021. PMID 6334459.

  • ^«Protamine Use During Pregnancy |». Archived from the original on 21 December 2016. Retrieved 14 December 2016.
  • ^ abKern, Morton J. (2012). The Interventional Cardiac Catheterization Handbook E-Book. Elsevier Health Sciences. p. 131. ISBN .
  • ^ abcdefgh«Protamine Sulfate».

    The American Society of Health-System Pharmacists. Archived from the original on 6 November 2016. Retrieved 8 December 2016.

  • ^Kenneth Cornetta; W.French Anderson (1989). «Protamine sulfate as an effective alternative to polybrene in retroviral-mediated gene-transfer: implications for human gene therapy». Journal of Virological Methods. 23 (2): 187–194. doi:10.1016/0166-0934(89)90132-8. PMID 2786000.
  • ^«Protamine Sulfate». International Drug Price Indicator Guide. Retrieved 8 December 2016.
  • ^WHO Model Formulary 2008(PDF).

    World Health Organization.

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    2009. p. 255. ISBN . Archived(PDF) from the original on 13 December 2016. Retrieved 8 December 2016.

  • ^ ab«Prosulf 10mg/ml Solution for Injection — Summary of Product Characteristics (SPC) — (eMC)». Archived from the original on 20 December 2016. Retrieved 14 December 2016.
  • ^Sokolowska, E; Kalaska, B; Miklosz, J; Mogielnicki, A. (2016). «The toxicology of heparin reversal with protamine: past, present and future».

    Expert Opinion on Drug Metabolism & Toxicology. 6 (8): 897–909.

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    doi:10.1080/17425255.2016.1194395. PMID 27223896.


It is a highly cationic peptide that binds to either heparin or low molecular weight heparin (LMWH) to form a stable ion pair, which does not own anticoagulant activity. The ionic complicated is then removed and broken below by the reticuloendothelial system. In large doses, protamine sulfate may also own an independent — however feeble — anticoagulant effect.

Significant warnings

  1. Low platelet levels warning. This drug can decrease your platelet levels. This is known as heparin-induced thrombocytopenia (HIT), which can eventually lead to the formation of blood clots in your veins. These clots can form even several weeks after you stop taking heparin. Your doctor will check you for low platelet levels.
  2. Bleeding risk warning. This drug may cause serious bleeding. This happens because this drug reduces your body’s ability to make your blood clot.

    Heparin may cause you to bruise more easily. It also may take your body longer to stop bleeding. This can cause death in rare cases. Let your doctor know if you own frequent nosebleeds, unusual bleeding from your gums, periods that are heavier than normal, red or brown urine, or dark or tarry stools. Also let your doctor know if you vomit blood, if your vomit looks love coffee grounds, or if you own headaches, dizziness, or weakness.


Protamine was originally isolated from the sperm of salmon, but is now mostly made by recombinant biotechnology.[3][8]

Adverse effects

Protamine has been reported to cause allergic reactions in patients who are allergic to fish, diabetics using insulin preparations containing protamine, and vasectomized or infertile men.[11][12] These happen at rates ranging from 0.28% to 6%.[12][13][14]

Avoiding rapid infusion of protamine sulfate and pre-treating at-risk patients with histamine receptor antagonists (H1 and H2) and steroids may minimize these reactions.

A 5 to 10 mg test dose is recommended following pretreatment before istering the full dose.[12]

External links

Highlights for heparin

  • Heparin comes in two forms. One is an injectable solution, which you inject under your skin. The other is a solution that’s injected intravenously (into one of your veins). Only your doctor can give you the intravenous form.
  • Heparin injectable solution only comes as a generic drug. It doesn’t own a brand-name version.
  • Heparin injectable solution is a blood thinner that’s used to treat and prevent blood clots.

Medical uses

Protamine sulfate is generally istered to reverse the large dose of heparin istered during certain surgeries, especially heart surgery where anti-coagulation is necessary to prevent clot formation within the cardiopulmonary bypass pump apparatus.

Before giving heparin what allergy to check for

A dose of protamine is given once the patient is off-pump, when extracorporeal circulation and anticoagulation are no longer needed.

It is also used in gene transfer, protein purification and in tissue cultures as a crosslinker for viral transduction. In gene therapy, protamine sulfate has been studied as a means to increase transduction rates by both viral and nonviral-mediated delivery mechanisms (e.g. utilizing cationic liposomes).[9][10]

Protamine is used in insulin aspart protamine and NPH insulin.


Dosage for heparin reversal is 1.0 to 1.5 mg protamine sulfate IV for every 100 IU of athletic heparin.

PTT should be monitored at 5 to 15 minutes after dose then in 2–8 hours afterward.

Before giving heparin what allergy to check for