Several different types of adverse reactions can follow intravenous administration of protamine sulfate.
All of the reactions involve some degree of systolic hypotension.
Type
Key Feature
Features
I
systemic hypotension
transient systemic hypotension following rapid administration
II
anaphylactoid reactions
systemic hypotension, bronchospasm, cardiovascular collapse, edema; right atrial and pulmonary pressures are low
IIA
anaphylaxis
IgE causally involved
IIB
anaphylactoid
IgE not causally involved
IIC
noncardiogenic pulmonary edema
pulmonary edema due to leakage of fluids into the alveoli; pulmonary artery pressures are not elevated; peripheral edema may be marked
III
pulmonary vasoconstriction
systemic hypotension and pulmonary hypertension; right atrial and pulmonary artery pressures are high, with acute right heart failure
where:
• Rapid administration involves giving the entire dose within 3 minutes.
• Noncardiogenic pulmonary edema occurs more than 15 minutes (may be over an hour) after the administration of the protamine. The other reactions occur immediately or shortly after the administration.
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