Complement activation from protamine sulfate administration after coronary angiography
Article first published online: 6 DEC 2005
Copyright © 1989 John Wiley & Sons, Ltd.
Catheterization and Cardiovascular Diagnosis
Volume 16, Issue 4, pages 221–225, April 1989
How to Cite
Click, R. L., Homburger, H. A. and Bove, A. A. (1989), Complement activation from protamine sulfate administration after coronary angiography. Cathet. Cardiovasc. Diagn., 16: 221–225. doi: 10.1002/ccd.1810160403
- Issue published online: 6 DEC 2005
- Article first published online: 6 DEC 2005
- Manuscript Revised: 22 SEP 1988
- Manuscript Accepted: 22 SEP 1988
- Manuscript Received: 5 APR 1988
- heart catheterization;
- heparin-protamine complex;
The cause of hypotension after reversal of heparin by protamine has not been well defined. In this study we evaluated complement activation (C3a and C4a) by the heparin-protamine complex in 46 consecutive patients (40 received protamine sulfate to reverse heparin, and six did not) during and after coronary angiography. In patients receiving protamine sulfate, there was a significant increase in C3a over the value before protamine sulfate administration (P<.001) or in patients who did not receive protamine sulfate (P<.05): 807 ± 100 ng/ml vs. 274 ± 75 ng/ml. There were no significant changes in C4a after protamine sulfate administration. These results indicate that the alternate complement pathway is activated when protamine sulfate is administered after coronary angiography. This may induce hypotension as well as platelet aggregation and thrombus formation and may contribute to coronary instability. Therefore, in unstable patients, heparin reversal by protamine should not be done routinely.