Abstract

Protamine is also used in the context of dialysis, invasive vascular procedures, and acute ischemic strokes to reverse
the anticoagulation effects of unfractionated heparin. Protamine sulfate is a fairly strong basic protein that binds
with the strongly acidic heparin to create a stable and inactive complex (salt) when given as an antidote to heparin.
It is a highly cationic peptide that forms a stable ion pair without any anticoagulant properties when it binds to
either heparin or low molecular weight heparin (LMWH). The positive cationic arginine peptide of protamine reacts
with unfractionated heparin, a strongly anionic anticoagulant, to form a salt aggregate. The metabolism of the
heparin-protamine salt aggregate is poorly understood