Protamine sulfate is a strong alkaline polypeptide used mainly to reverse the anticoagulant effects of heparin. When injected intravenously, the alkaline protamine combines with the acidic heparin to form a neutral salt, thereby annulling heparin’s anticoagulating properties. The controversy over heparin reversal with protamine during carotid endarterectomy (CEA) is a surgical Rorschach test. Like the inkblots psychiatrists use to probe a patient’s subconscious, reports on clinical adverse responses to protamine tell more about the reader than about the information at hand.
Baracchini C, Ballotta E. The Benefit of Heparin Reversal With Protamine During Carotid Endarterectomy. JAMA Surg. 2016;151(3):255-256. doi:10.1001/jamasurg.2015.3615