Successful On-Pump Coronary Artery Bypass Without Using Protamine

Abstract

A 48-year-old woman presented with a history of angina and breathlessness on exertion. She was diagnosed to have critical left main stem coronary artery disease along with a blocked right coronary artery. She was also allergic to protamine. After multidisciplinary consultation, it was decided to use heparin without protamine for reversal. She underwent successful on-pump coronary artery bypass grafting (CABG) without excessive blood loss. The disadvantages were a longer total operating time and the use of blood products to achieve normal coagulation. This case report describes the successful management of this complex problem.