Vonk AB, Veerhoek D, van den Brom CE, van Barneveld LJ, Boer C. Individualized heparin and protamine management improves rotational thromboelastometric parameters and postoperative hemostasis in valve surgery. J Cardiothorac Vasc Anesth 2014;28:235 41. 93. Koster A, Borgermann J, Gummert J, Rudloff M, Zittermann A, Schirmer U. Protamine overdose and its impact on coagulation, bleeding, and transfusions after Ann Thorac Surg 2018;105:650 62 ANTICOAGULATION DURING CARDIOPULMONARY BYPASS REPORT cardiopulmonary bypass: results of a randomized double- blind controlled pilot study. Clin Appl Thromb Hemost 2014;20:290 5. 94. Mochizuki T, Olson PJ, Szlam F, Ramsay JG, Levy JH. Protamine reversal of heparin affects platelet aggregation and activated clotting time after cardiopulmonary bypass. Anesth Analg 1998;87:781 5. 95. Carr ME, Carr SL. At high heparin concentrations, prot- amine concentrations which reverse heparin anticoagulant effects are insuf cient to reverse heparin anti-platelet ef- fects. Thromb Res 1994;75:617 30. 96. Dunning J, Versteegh M, Fabbri A, et al. Guideline on an- tiplatelet and anticoagulation management in cardiac sur- gery. Eur J Cardiothorac Surg 2008;34:73 92. 97. Martin P, Horkay F, Gupta NK, Gebitekin C, Walker DR. Heparin rebound phenomenon much ado about nothing? Blood Coagul Fibrinolysis 1992;3:187 91. 98. Taneja R, Marwaha G, Sinha P, et al. Elevated activated partial thromboplastin time does not correlate with heparin rebound following cardiac surgery. Can J Anaesth 2009;56: 489 96. 99. Teoh KH, Young E, Blackall MH, Roberts RS, Hirsh J. Can extra protamine eliminate heparin rebound following car- diopulmonary bypass surgery? J Thorac Cardiovasc Surg 2004;128:211 9. 100. Nybo M, Madsen JS. Serious anaphylactic reactions due to protamine sulfate: a systematic literature review. Basic Clin Pharmacol Toxicol 2008;103:192 6. 101. Boigner H, Lechner E, Brock H, Golej J, Trittenwein G. Life threatening cardiopulmonary failure in an infant following protamine reversal of heparin after cardiopulmonary bypass. 