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.