The contemporary role of protamine in the cardiac catheterization laboratory

Barbara A. Danek, Kathleen E. Kearney, Christine J. Chung, Zachary Steinberg, William L. Lombardi, James M. McCabe, Lorenzo Azzalini

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Access to the arterial circulation and full anticoagulation carries a risk of serious bleeding during and after percutaneous coronary intervention. Important sources of bleeding include the arterial access site and coronary artery perforation. Prompt and effective management of hemorrhagic complications is an essential interventional skill. Protamine sulfate is well-known as a heparin reversal agent. Despite this, there is heterogeneity in the use of protamine during interventional procedures. While protamine is generally well-tolerated, it is associated with a risk of hypersensitivity reaction, including anaphylaxis, among others. The purpose of this review is to summarize the existing evidence about and experience with the use of protamine sulfate in the setting of percutaneous coronary and structural interventional procedures.

Original languageEnglish
Pages (from-to)111-120
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Issue number1
StatePublished - 1 Jul 2023
Externally publishedYes


  • bleeding
  • complications
  • perforation
  • protamine sulfate


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