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Invited Commentary
March 2016

The Benefit of Heparin Reversal With Protamine During Carotid Endarterectomy

Author Affiliations
  • 1Stroke Unit and Neurosonology Lab, Department of Neuroscience, University of Padua School of Medicine, Padova, Italy
  • 2Vascular Study Group, 2nd Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
JAMA Surg. 2016;151(3):255-256. doi:10.1001/jamasurg.2015.3615

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.

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