Conclusion: Protamine adversely affects clot initiation time, clot kinetics and platelet function in a dose-dependent manner, which can predispose to bleeding.

What are the side effects of protamine?

The most common adverse effect associated with protamine administration includes an anaphylactic response consisting of systemic hypotension, pulmonary vasoconstriction, allergic reactions, pulmonary hypertension, bronchoconstriction, and bradycardia. The incidence of anaphylactic reactions ranges from 0.06% to 10.6%.

How does protamine cause anticoagulation?

Whilst protamine primarily neutralises heparin, protamine has anticoagulant properties that are attributed to an inter- action with platelet function, interference with coagulation factors, and stimulation of clot breakdown.