Protamine has a black box warning that describes serious reactions (including cardiovascular collapse) to certain patients especially those known to be of higher risk (such as use of protamine-containing drugs including NPH insulin, allergy to fish, previous vasectomy, etc.).
• In light of this warning, do you have a protocol in place to note if the patient is at a higher risk for a reaction before procedures?
• Are you giving test doses of 5 mg to patients? If so, has this helped to prevent serious reactions?
• Are your OR and Cath Lab staff aware of these reactions? If so, how was (is) this information communicated?
• Is Protamine restricted in any way at your facility?

Thank you for your help with these questions.