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Purified procoagulant mixture of low molecular weight cationic proteins used in reversal of heparin anticoagulation. Considerations include cautious administration to avoid rapid elevation in pulmonary vascular-resistance, fall in systemic vascular-resistance, and be alert for signs of anaphylaxis.

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Dose. 1mg/100u heparin administered within the last hour (or 0.5mg/100u heparin administered more than >1hr ago). #ref

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Dose to reverse heparin anticoagulation following cardiopulmonary bypass in paediatrics = 4mg/kg.

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Administer slowly whilst monitoring haemodynamics for evidence of reduced cardiac output.
Protamine elevates pulmonary vascular-resistance (thromboxane release) and reduces SVR (histamine release).

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High incidence of anaphylaxis. Commence with test dose. #ref #improve

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Protamine is a positively charged base that binds negatively charged acidic heparin to form a salt which is removed by reticuloendothelial system.

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