Fatal anaphylactoid response to protamine after percutaneous transluminal coronary angioplasty.
A generalized skin erythema and severe hypotension developed following administration of protamine for the reversal of heparin anticoagulation after an unsuccessful attempt at percutaneous transluminal angioplasty in a patient who had never been exposed to protamines before. Evidence of classical pathway complement activation was present indicating that this reaction could have been triggered by a non-immunological mechanism. The patient could not adequately be resuscitated because of the presence of severe coronary artery disease.
Neidhart
P P
PP
Department of Anaesthesia, University Hospital of Geneva, Switzerland.
Meier
B
B
Polla
B S
BS
Schifferli
J A
JA
Morel
D R
DR
D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced*; D015906:Angioplasty, Balloon, Coronary; D003176:Complement C3 / Q000032:analysis; D003179:Complement C3b / Q000032:analysis; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D007123:Immunoelectrophoresis, Two-Dimensional; D008297:Male; D011479:Protamines / Q000009:adverse effects*
D003176:Complement C3; D011479:Protamines; D003179:Complement C3b