Comparison of effects of protamine and polybrene, with special emphasis on the factor VIII (antihemophilic globulin) deficiency induced.

Successful achievement of extracorporeal circulation requires that blood coagulability be temporarily interrupted during perfusion and afterward restored to normal. Heparin is accepted as the drug of choice in rendering the blood incoagulable, but there are two drugs, protamine and Polybrene (hexadimethrine bromide), available for effective in vivo neutralization of heparin, and controversy exists as to which of these should be used. In an effort to determine which of these heparin antagonists is superior, comparative studies on protamine and Polybrene were carried out to evaluate heparin neutralization, physiological and hematological effects, and such other matters as may be of practical importance. In the course of these studies an unexpected fact became apparent. The intravenous injection of protamine or Polybrene resulted in a coagulation factor deficiency, persisting long after the temporary anticoagulant effect of the heparin neutralizer had disappeared. It was possible to demonstrate that a striking loss of Factor VIII (antihemophilic globulin) had been induced.