To the Editor: Weiss et al. (April 6 issue)1 have made an important contribution by demonstrating the presence of IgE and IgG antibodies in patients with life-threatening protamine reactions after heparin reversal. However, they further suggest that screening of patients at high risk, such as those receiving insulin preparations containing protamine, may be of value. I question whether this approach is cost effective in view of the low incidence of protamine reactions. We have reported a 2 percent (1 of 50) incidence of protamine reactions in patients receiving neutral protamine Hagedorn insulin in our prospective study of 1551 cardiac-surgery patients,.
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