After cardiac surgery, which complication can arise from the use of protamine?

The use of protamine after cardiac surgery is primarily aimed at reversing the anticoagulation effects of heparin, which is commonly used during cardiopulmonary bypass. However, the administration of protamine can lead to some specific complications. One of the most significant is the risk of anaphylaxis, particularly in patients who are allergic to fish (since protamine is derived from fish sperm) or have had prior exposure to protamine.

In addition to anaphylaxis, a heparin rebound can occur after protamine administration. This happens when the effect of protamine wears off, causing a sudden increase in circulating heparin levels that can result in increased bleeding risks. Understanding these risks is crucial for the management of patients postoperatively, as both anaphylaxis and heparin rebound require immediate recognition and intervention to mitigate serious complications.

Other potential complications like anemia, sepsis, or myocardial ischemia are associated with cardiac surgery but are not directly linked to protamine use. Anemia can occur from blood loss during and after surgery, sepsis is a separate infectious complication, and myocardial ischemia generally results from issues related to coronary perfusion, rather than the medication used for anticoagulation reversal. Thus, the association of