Hamid Kamalipour, Karmella Kamali, Maryam Rivaz.
Clemastine to prevent adverse effects of Protamin sulfate after coronary artery bypass graft surgery.
Anesth Pain Intens Care Jan ;11(2):79-83.

Background: Heparin is the only widely used pharmacologic agent for anticoagulation during coronary artery bypass graft surgery (CABG). Failure of adequate and prompt heparin reversal by protamine sulfate can result in hemodynamic instability. Protamine has various side effects. Clemastine as an H1 receptor blocking agent shows positive inotropic effect but not some side effects of non-sedative antihistamines such as cardiac arrhythmia. The aim of this study was to evaluate the effect of clemastine on several hemodynamic responses after protamine sulfate administration in patients subjected to CABG. Methods: In a prospective randomized controlled trial, 60 patients aged 34-87, with the ASA class II to IV and cardiac ejection fraction =50% who subjected to elective CABG were enrolled to two equal groups. Patients in group 1 received normal saline (2ml) intravenously as placebo before the operation was completed. Patients in group 2 received clemastine 2 mg (2ml) intravenously at the same time as group 1. After the operation all patients received slowly infusion of protamine sulfate within 7 minutes, through peripheral vein. Results: Change of MAP in 5 minutes after protamine administration was clinically significant in group 1. No drop in MAP in 5 and 10 minutes after protamine administration was seen in group 2. There was a significant increase in heart rate in 5 and 10 minutes after protamine administration in group 1. There was no significant rise in heart rate before and after protamine administration in group 2. Conclusion: Clemastine can prevent MAP decrease after protamine administration in patients subjected to coronary artery bypass graft surgery.

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