Management of protamine allergy with bivalirudin during coronary artery revascularization.
A patient with impaired left ventricular function was scheduled for coronary artery bypass grafting. The patient's history revealed a life-threatening allergy to fish proteins. Therefore, because of the threat of cross-reactivity to protamine, a standard anticoagulation protocol with heparin/protamine was disapproved. Instead, complete coronary artery revascularization was successfully performed off-pump using bivalirudin as the anticoagulant.
Koster
Andreas
A
Department of Anesthesia, Herzzentrum Lahr/Baden, Lahr, Germany. ankoster@t-online.de
Rosendahl
Ulrich
U
von Hodenberg
Eberhard
E
Ennker
Jürgen
J
D000707:Anaphylaxis / Q000139:chemically induced / Q000517:prevention & control; D000925:Anticoagulants / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000601:surgery*; D004342:Drug Hypersensitivity / Q000517:prevention & control*; D006494:Heparin Antagonists / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D011479:Protamines / Q000009:adverse effects*; D011994:Recombinant Proteins / Q000627:therapeutic use
D000925:Anticoagulants; D006494:Heparin Antagonists; D006629:Hirudins; D010446:Peptide Fragments; D011479:Protamines; D011994:Recombinant Proteins; C074619:bivalirudin