Journal article
Risk factors for clinically important adverse events after protamine administration following cardiopulmonary bypass
Journal of the American College of Cardiology, v 32(7), pp 1916-1922
01 Dec 1998
PMID: 9857872
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Abstract
Objectives. The purpose of this study was to determine risk factors for adverse events following protamine administration after cardiopulmonary bypass.
Background. Intravenous protamine administration is associated with a risk of severe systemic reactions. However, risk factors for these events have not been well delineated, thus hampering development of preventive strategies.
Methods. A case–control study nested within a cohort of consecutive patients undergoing surgery requiring cardiopulmonary bypass was performed. The primary case definition included those events (pulmonary hypertensive and systemic hypotensive) occurring within 10 min of protamine administration in the absence of other measurable causes of hemodynamic compromise.
Results. Comparing the 53 cases to the 223 control subjects, three risk factors were independently associated with events (multivariable odds ratio [95% confidence interval]): neutral protamine Hagedorn insulin use (8.18 [2.08, 32.2]); fish allergy (24.5 [1.24, 482.3]), and a history of nonprotamine medication allergy (2.97 [1.25, 7.07]). These risk factors demonstrated an increasingly strong association with progressively more specific case definitions. An estimated 39% of cardiopulmonary bypass patients had one or more of these risk factors. Prior intravenous protamine, central venous pressure prior to protamine, preoperative ejection fraction and the need for inotropes when coming off bypass did not exhibit statistically significant associations with events (all p > 0.15). Prior protamine allergy was associated specifically with an increased risk of pulmonary hypertension (multivariable odds ratio 189; 95% confidence interval 13, 2,856).
Conclusions. Immunologic factors are important in predisposing individuals to protamine reactions, and a substantial proportion of patients are at considerably increased risk. Strategies to reduce the risk of protamine-associated events are needed.
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Details
- Title
- Risk factors for clinically important adverse events after protamine administration following cardiopulmonary bypass
- Creators
- Stephen E Kimmel - University of PennsylvaniaMikkael A Sekeres - University of PennsylvaniaJesse A Berlin - University of PennsylvaniaNorig Ellison - Hospital of the University of PennsylvaniaVerdi J DiSesa - Allegheny CollegeBrian L Strom - University of Pennsylvania
- Publication Details
- Journal of the American College of Cardiology, v 32(7), pp 1916-1922
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000077396200019
- Scopus ID
- 2-s2.0-0032421581
- Other Identifier
- 991021463552104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems