Biotech Values

[biomaven0]

>>UFH already has a satisfactory reversing agent (protamine)<<

Protamine is of course routinely used for want of anything better, but I wouldn't characterize it as satisfactory. It has to be individually and carefully titrated, and not infrequently causes hemodynamic instability, usually minor but sometimes major or even fatal. I've seen in one article a figure of 2.6% for major adverse events from protamine in cardiac surgery. This paper also showed a significantly increased in-hospital mortality after even minor systemic hypotension or pulmonary hypertension within 30 minutes of protamine administration, but hard to know if that is correlative or causative. Protamine does activate the complement system, which is very likely a bad thing in a cardiac patient and maybe could explain the increased mortality after even minor reactions. (Of course it could be that patients that react poorly to protamine are simply sicker to begin with). Up to now there has really been no way to do a trial to figure this out because of the want of any alternative to protamine.

Peter