Journal article
Association of Protamine IgE and IgG Antibodies with Life-Threatening Reactions to Intravenous Protamine
The New England journal of medicine, v 320(14), pp 886-892
06 Apr 1989
PMID: 2648147
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Abstract
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. In diabetic patients who had received protamine-insulin injections, the presence of serum antiprotamine IgE antibody was a significant risk factor for acute protamine reactions (relative risk, 95; P = 1.0x10-5), as was antiprotamine IgG (relative risk, 38; P = 1.2x10-5). No patients without previous exposure to protamine-insulin injections had serum protamine IgE antibodies. In this group, antiprotamine IgG antibody was a risk factor for protamine reactions (relative risk, 25; P = 0.0062). We conclude that in protamine-insulin-dependent diabetics, the increased risk of serious reactions when intravenous protamine was given appeared to be caused largely by antibody-mediated mechanisms. In nondiabetic subjects, the presence of protamine IgG was significantly associated with an increased risk of acute protamine reactions, although many nondiabetic subjects who had reactions had no IgG antibodies. (N Engl J Med 1989; 320:886-92.)
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Details
- Title
- Association of Protamine IgE and IgG Antibodies with Life-Threatening Reactions to Intravenous Protamine
- Creators
- Michael E Weiss - Department of Medicine; Johns Hopkins University School of Medicine; BaltimoreDaniel NyhanZhikang Peng - Johns Hopkins UniversityJan C HorrowEdward Lowenstein - Harvard University ,Carol Hirshman - Johns Hopkins UniversityN Franklin AdkinsonJay C Horrow - Anesthesiology and Perioperative Medicine
- Publication Details
- The New England journal of medicine, v 320(14), pp 886-892
- Publisher
- Massachusetts Medical Society
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Anesthesiology and Perioperative Medicine
- Web of Science ID
- WOS:A1989T953400002
- Scopus ID
- 2-s2.0-0024598118
- Other Identifier
- 991019184074104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Anesthesiology