{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:41:48Z","timestamp":1791546108920,"version":"4.3.4"},"reference-count":62,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Protamine, first isolated from salmon fish sperm and now produced through recombinant biotechnology, is an antidote that neutralizes the anticoagulant properties of heparin. Protamine function is based on the capacity to dissociate the heparin\u2013antithrombin III (AT III) complex (an important link that promotes blood fluidification by inhibiting coagulation), forming the inactive heparin\u2013protamine complex. Protamine has itself dose-dependent anticoagulant properties: It interferes with coagulation factors and platelet function; it stimulates fibrinolysis; it can lead to thrombocytopenia and reduction in thrombin-related platelet aggregation; it decreases platelet response to thrombin receptor agonist in a dose-dependent manner. In this review, we will focus on protamine and its interaction with heparin. Notably, protamine is able to antagonize not only unfractionated heparin (UFH) but also low molecular weight heparins to various degrees. Protamine-allergic and anaphylactoid systemic reactions may affect up to 1 in 10 people and should be prevented and treated early.<\/jats:p>","DOI":"10.4103\/aca.aca_117_23","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T11:03:08Z","timestamp":1720090988000},"page":"202-212","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":26,"title":["Protamine and Heparin Interactions: A Narrative Review"],"prefix":"10.4103","volume":"27","author":[{"given":"Martina","family":"Crivellari","sequence":"first","affiliation":[{"name":"IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Landoni","sequence":"additional","affiliation":[{"name":"IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy"},{"name":"Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"D\u2019Andria Ursoleo","sequence":"additional","affiliation":[{"name":"IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Ferrante","sequence":"additional","affiliation":[{"name":"Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Oriani","sequence":"additional","affiliation":[{"name":"IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"R1-20240901","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1186\/gb-2007-8-9-227","article-title":"The protamine family of sperm nuclear 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