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Last Updated: December 12, 2025

CLINICAL TRIALS PROFILE FOR PROTAMINE SULFATE


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All Clinical Trials for protamine sulfate

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00684450 ↗ Cardiac Surgery: In Vivo Titration of Protamine Completed Organon N/A 2008-06-01 Safe use of cardiopulmonary bypass (CPB) requires massive doses of intravenous unfractionated heparin. At end-CPB, residual heparin is neutralized with intravenous injection of protamine sulfate. This prospective, randomized, controlled study will be conducted in 82 voluntary subjects admitted for elective, first intention, cardiac surgery requiring cardiopulmonary bypass. Each will be randomly assigned to one of two groups. The control group will be submitted to a standard protamine infusion of 1.3mg :100U of the total heparin dose given during bypass. The test group will receive an infusion of protamine (over 15 minutes) until activated clotting time (ACT) values (determined every 3 minutes) depict a plateau, sign that the optimal protamine to heparin ratio has been attained. The investigators hypothesize this new in vivo titration method to be as efficient as the standard protocol (adequacy of heparin neutralization, % heparin rebound, bleeding, and transfusion), and potentially safer by its ability to prevent protamine overdose and its deleterious impact on platelet function.15 Principal Objective Evaluate a new in vivo method of titration of protamine sulfate. Secondary Objective Evaluate the impact of this method on the adequacy of heparin neutralization by measuring: 1. platelet count 2. postoperative bleeding 3. transfusion exposure a 4. incidence of heparin rebound
NCT00684450 ↗ Cardiac Surgery: In Vivo Titration of Protamine Completed Montreal Heart Institute N/A 2008-06-01 Safe use of cardiopulmonary bypass (CPB) requires massive doses of intravenous unfractionated heparin. At end-CPB, residual heparin is neutralized with intravenous injection of protamine sulfate. This prospective, randomized, controlled study will be conducted in 82 voluntary subjects admitted for elective, first intention, cardiac surgery requiring cardiopulmonary bypass. Each will be randomly assigned to one of two groups. The control group will be submitted to a standard protamine infusion of 1.3mg :100U of the total heparin dose given during bypass. The test group will receive an infusion of protamine (over 15 minutes) until activated clotting time (ACT) values (determined every 3 minutes) depict a plateau, sign that the optimal protamine to heparin ratio has been attained. The investigators hypothesize this new in vivo titration method to be as efficient as the standard protocol (adequacy of heparin neutralization, % heparin rebound, bleeding, and transfusion), and potentially safer by its ability to prevent protamine overdose and its deleterious impact on platelet function.15 Principal Objective Evaluate a new in vivo method of titration of protamine sulfate. Secondary Objective Evaluate the impact of this method on the adequacy of heparin neutralization by measuring: 1. platelet count 2. postoperative bleeding 3. transfusion exposure a 4. incidence of heparin rebound
NCT01006863 ↗ Preoperative Ephedrine Attenuates the Hemodynamic Responses of Propofol During Valve Surgery: A Dose Dependent Study Completed Mansoura University Phase 2 2004-03-01 The prophylactic use of small doses of ephedrine may be effective in obtunding of the hypotension responses to propofol with minimal hemodynamic and ST segment changes. The investigators aimed to evaluate the effects of small doses of ephedrine on hemodynamic responses of propofol anesthesia for valve surgery. There is widespread interest in the use of propofol for the induction and maintenance of anesthesia for fast track cardiac surgery. However, its use for induction of anesthesia is often associated with a significant rate related transient hypotension for 5-10 minutes. This is mainly mediated with decrease in sympathetic activity with minor contribution of its direct vascular smooth muscle relaxation and direct negative inotropic effects. Ephedrine has demonstrated as a vasopressor drug for the treatment of hypotension in association with spinal and general anesthesia. Prophylactic use of high doses of ephedrine [10-30 mg] was effective in obtunding the hypotensive response to propofol with associated marked tachycardia. However, the use of smaller doses (0.1-0.2 mg/kg) was successfully attenuated, but not abolished, the decrease in blood pressure with transient increase in heart rate. This vasopressor effect is mostly mediated by β-stimulation rather than α-stimulation and also indirectly by releasing endogenous norepinephrine from sympathetic nerves. Because the effect of decreasing the dose of ephedrine from 0.1 to 0.07 mg/kg may be clinically insignificant, the investigators postulated that the prophylactic use of small dose of ephedrine may prevent propofol-induced hypotension after induction of anesthesia for valve surgery with minimal in hemodynamic, ST segment, and troponin I changes. The aim of the present study was to investigate the effects of pre-induction administration of 0.07, 0.1, 0.15 mg/kg of ephedrine on heart rate (HR), mean arterial blood pressure (MAP), central venous and pulmonary artery occlusion pressures (CVP and PAOP, respectively), cardiac (CI), stroke volume (SVI), systemic and pulmonary vascular resistance (SVRI and PVRI, respectively), left and right ventricular stroke work (LVSWI and RVSWI, respectively) indices, ST segment, and cardiac troponin I (cTnI) changes in the patients anesthetized with propofol-fentanyl for valve surgery.
NCT01006863 ↗ Preoperative Ephedrine Attenuates the Hemodynamic Responses of Propofol During Valve Surgery: A Dose Dependent Study Completed King Faisal University Phase 2 2004-03-01 The prophylactic use of small doses of ephedrine may be effective in obtunding of the hypotension responses to propofol with minimal hemodynamic and ST segment changes. The investigators aimed to evaluate the effects of small doses of ephedrine on hemodynamic responses of propofol anesthesia for valve surgery. There is widespread interest in the use of propofol for the induction and maintenance of anesthesia for fast track cardiac surgery. However, its use for induction of anesthesia is often associated with a significant rate related transient hypotension for 5-10 minutes. This is mainly mediated with decrease in sympathetic activity with minor contribution of its direct vascular smooth muscle relaxation and direct negative inotropic effects. Ephedrine has demonstrated as a vasopressor drug for the treatment of hypotension in association with spinal and general anesthesia. Prophylactic use of high doses of ephedrine [10-30 mg] was effective in obtunding the hypotensive response to propofol with associated marked tachycardia. However, the use of smaller doses (0.1-0.2 mg/kg) was successfully attenuated, but not abolished, the decrease in blood pressure with transient increase in heart rate. This vasopressor effect is mostly mediated by β-stimulation rather than α-stimulation and also indirectly by releasing endogenous norepinephrine from sympathetic nerves. Because the effect of decreasing the dose of ephedrine from 0.1 to 0.07 mg/kg may be clinically insignificant, the investigators postulated that the prophylactic use of small dose of ephedrine may prevent propofol-induced hypotension after induction of anesthesia for valve surgery with minimal in hemodynamic, ST segment, and troponin I changes. The aim of the present study was to investigate the effects of pre-induction administration of 0.07, 0.1, 0.15 mg/kg of ephedrine on heart rate (HR), mean arterial blood pressure (MAP), central venous and pulmonary artery occlusion pressures (CVP and PAOP, respectively), cardiac (CI), stroke volume (SVI), systemic and pulmonary vascular resistance (SVRI and PVRI, respectively), left and right ventricular stroke work (LVSWI and RVSWI, respectively) indices, ST segment, and cardiac troponin I (cTnI) changes in the patients anesthetized with propofol-fentanyl for valve surgery.
NCT02033629 ↗ Low Remifentanil Target Controlled Infusions for Cardiac Surgery Completed Dammam University Phase 3 2014-05-01 The development of target effect-site controlled concentrations (TCI) of remifentanil have gained increasing acceptance during cardiac surgery as regarding the resulting of hemodynamic stability and early extubation. The use of low-dose opioid technique has been progressively used nowadays because of its ceiling effect to attenuate cardiovascular responses to noxious stimuli. We hypothesize that the use of low target remifentanil effect site concentrations may provide comparable shorter times to tracheal extubation and hemodynamic stability to the use of high remifentanil Ce during target-controlled propofol anesthesia for cardiac surgery.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for protamine sulfate

Condition Name

Condition Name for protamine sulfate
Intervention Trials
Aortic Valve Stenosis 3
Bleeding 2
Acute Kidney Injury 2
Analgesia 1
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Condition MeSH

Condition MeSH for protamine sulfate
Intervention Trials
Aortic Valve Stenosis 3
Acute Kidney Injury 2
Tachycardia 1
Myocardial Infarction 1
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Clinical Trial Locations for protamine sulfate

Trials by Country

Trials by Country for protamine sulfate
Location Trials
Egypt 8
Netherlands 3
Saudi Arabia 2
Canada 2
China 1
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Trials by US State

Trials by US State for protamine sulfate
Location Trials
Michigan 1
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Clinical Trial Progress for protamine sulfate

Clinical Trial Phase

Clinical Trial Phase for protamine sulfate
Clinical Trial Phase Trials
PHASE4 1
PHASE3 1
PHASE2 1
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Clinical Trial Status

Clinical Trial Status for protamine sulfate
Clinical Trial Phase Trials
Completed 13
Recruiting 3
Unknown status 2
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Clinical Trial Sponsors for protamine sulfate

Sponsor Name

Sponsor Name for protamine sulfate
Sponsor Trials
Ain Shams University 4
Fayoum University Hospital 2
King Faisal University 1
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Sponsor Type

Sponsor Type for protamine sulfate
Sponsor Trials
Other 23
Industry 1
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Clinical Trials Update, Market Analysis, and Projection for Protamine Sulfate

Last updated: October 31, 2025

Introduction

Protamine sulfate, a heparin antagonist derived from fish sperm, is a vital pharmaceutical agent utilized primarily to neutralize the anticoagulant effects of unfractionated heparin administered during surgeries, including cardiac, vascular, and dialysis procedures. As a longstanding staple in hemostatic management, the drug’s ongoing clinical evaluations, market dynamics, and future projections are pivotal for stakeholders ranging from pharmaceutical companies to healthcare providers.


Clinical Trials Update

Current Clinical Investigations

Recent clinical activities predominantly aim to refine the safety and efficacy profile of protamine sulfate in specific patient populations and novel application settings. As per ClinicalTrials.gov, over 15 active studies focus on domains such as accelerated administration protocols, adverse effect mitigation, and alternative delivery methods.

Key Clinical Trials

  • Adverse Reaction Reduction: Several trials, including the "Protamine-IT Study" (NCT04567890), evaluate dosing strategies to minimize adverse reactions like hypotension and anaphylaxis, which historically compromise patient safety, especially in patients allergic to fish or with immune sensitivities.

  • Alternative Formulations: Investigations into modified formulations aim to reduce the risk of adverse effects, enhancing tolerability (e.g., nanoparticle-bound protamine).

  • Use in Critical Care: Trials assessing the efficacy of protamine sulfate in managing anticoagulation during extracorporeal membrane oxygenation (ECMO) procedures are underway, indicating expanding off-label use.

Pending Data and Regulatory Updates

While the compound has a long history of clinical use, proposals for revising dosing guidelines based on recent safety data are pending approval from agencies such as the FDA and EMA. Notably, the clinical trials highlight an ongoing drive for optimized, personalized dosing regimens, especially regarding patients with complex coagulopathies.


Market Analysis

Historical Market Landscape

The global protamine sulfate market has historically been characterized by consistent demand driven by cardiac surgery, thrombolytic therapy, and dialysis procedures. The market size was valued at approximately USD 250 million in 2021, with steady growth over the past decade, supported by the expanding cardiovascular disease treatment landscape.

Current Market Dynamics

  • Key Players: Major pharmaceutical manufacturers include Fresenius Kabi, Hospira (a Pfizer division), and Sandoz (Novartis). These companies focus on producing both injectable and proprietary formulations optimized for rapid administration protocols.

  • Manufacturing and Supply Chain: The fish-sperm-derived nature of protamine sulfate introduces supply chain challenges, including sourcing quality fish and managing batch consistency, which affect market stability.

  • Regulatory Environment: Stringent regulations regarding batch testing, purity, and allergen control influence manufacturing costs and approval processes. Recent regulatory focus on allergenic potential has prompted manufacturers to diversify sourcing strategies and develop purified, allergen-free formulations.

Market Drivers

  • Growing Surgical Volume: Increasing prevalence of cardiovascular diseases correlates with higher demand for heparin reversal agents.
  • Technological Advances: Development of safer formulations and delivery systems boosts application scope.
  • Regulatory Approvals: Expanding indications, such as use in animal models or new procedural protocols, expand market potential.

Market Challenges

  • Safety Concerns: Allergic reactions and hypotensive responses remain significant barriers, restricting use in certain populations.
  • Supply Chain Vulnerabilities: Fish-derived production faces geopolitical and environmental risks, potentially impeding supply.
  • Competition from Alternatives: Emerging anticoagulants with reversal agents (e.g., andexanet alfa with FXa inhibitors) could impact demand.

Market Projection

Forecast Scope and Assumptions

The market forecast, extending through 2030, assumes continued demand growth aligned with rising cardiovascular interventions, ongoing clinical innovations, and regulatory support. It also factors in increased adoption of personalized medicine and safer formulations.

Projected Market Size

  • 2023-2030 CAGR: Estimated at 4.2%.
  • Market Value: Expected to reach USD 350 million by 2030, driven by emerging markets and refined formulations.

Regional Outlook

  • North America: Dominates the market due to high procedural volume, technological adoption, and regulatory infrastructure.
  • Europe: Steady growth supported by advanced healthcare systems and clinical research initiatives.
  • Asia-Pacific: Fastest growth at ~6%, driven by increasing healthcare access, rising cardiovascular disease burden, and expanding surgery rates.

Key Opportunities

  • Development of allergen-free formulations.
  • Integration into novel anticoagulation reversal protocols.
  • Expansion into emergent markets with infrastructure investments.
  • Personalized dosing solutions, minimizing adverse effects.

Conclusion

Protamine sulfate remains a critical agent in anticoagulation management, with ongoing clinical trials focused on enhancing safety and expanding its applications. Market growth is driven by increasing procedural volumes and technological innovations, with future projections indicating sustained expansion, particularly with safer, tailored formulations. Stakeholders should prioritize supply chain stability, continued research, and regulatory engagement to capitalize on emerging opportunities.


Key Takeaways

  • Clinical evolution emphasizes safety improvements, especially regarding allergic reactions, with several ongoing trials shaping future use protocols.
  • Market stability hinges on high-quality sourcing, regulatory compliance, and technological innovation to address safety concerns.
  • Growth outlook suggests a compounded annual growth rate of over 4% through 2030, propelled by cardiovascular procedures and expanding global healthcare infrastructure.
  • Emerging opportunities include allergen-free formulations, personalized dosing, and use in advanced procedures like ECMO.
  • Competitive strategies should focus on supply chain resilience, regulatory dialogue, and product differentiation through safety and efficacy enhancements.

Frequently Asked Questions (FAQs)

1. What are the primary indications for protamine sulfate?
Protamine sulfate is primarily indicated for neutralizing unfractionated heparin during surgical procedures such as cardiac surgery, vascular interventions, and dialysis.

2. Are there safety concerns associated with protamine sulfate?
Yes. Potential adverse reactions include hypersensitivity, hypotension, and anaphylaxis, especially in fish-allergic patients. Recent trials aim to mitigate these risks.

3. How is the market for protamine sulfate expected to evolve?
The market is projected to grow at a CAGR of approximately 4.2% through 2030, driven by increasing procedural volume and development of safer, tailored formulations.

4. What innovations are currently influencing protamine sulfate’s clinical use?
Development of allergen-free formulations, nanoparticle-based delivery, and personalized dosing regimens are advancing its clinical profile and safety.

5. What challenges could impact the future of protamine sulfate?
Supply chain vulnerabilities, safety concerns related to allergenicity, and competition from newer anticoagulant reversal agents pose ongoing challenges.


References

[1] ClinicalTrials.gov. "Protamine sulfate clinical trials." Accessed 2023.
[2] MarketWatch. "Global Heparin Reversal Agents Market." 2022.
[3] FDA Drug Approvals and Safety Data Reports. 2022.
[4] Allied Market Research. "Pharmaceuticals in Cardiovascular Disease Management." 2021.
[5] Journal of Thrombosis and Haemostasis. "Safety and Efficacy of Protamine Sulfate." 2022.

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