Anaphylaxis to Protamine During a Carotid Endarterectomy

Protamine sulfate is commonly used to reverse the anticoagulant effects of unfractionated heparin (UFH) during surgical procedures, but its administration can sometimes trigger severe adverse reactions, including life-threatening anaphylaxis. We present the case of a 77-year-old male undergoing carotid endarterectomy who developed profound hypotension and tachycardia following protamine infusion. Anaphylaxis was confirmed by elevated tryptase levels. This case emphasizes the importance of vigilant monitoring during protamine administration, particularly in high-risk patients, and highlights the need to consider alternative reversal strategies to enhance patient safety.