Three Cases of Anaphylaxis to Protamine: Management of Anticoagulation Reversal
Case 1
A 78-year-old male diabetic patient underwent elective coronary artery bypass grafting (CABG). His insulin therapy had been changed recently to human insulin (Humulin M3; Eli Lilly Italia, Sesto Fiorentino), which contains protamine sulfate. He reported multiple allergies and had experienced episodes of angioedema after switching to Humulin.
After CABG, the patient was weaned from CPB; had stable hemodynamics, with a mean arterial pressure of 60 mmHg; and ventilation resumed with similar