Protamine does not increase risk of stroke in patients with elective carotid stenting

Reversal of anticoagulation with protamine might predispose to a higher risk of stroke in patients with carotid stenting. We evaluated a national, multihospital patient database to examine the risk of stroke in patients with carotid stenting receiving protamine compared with those who did not.

The Premier Perspective database was used to identify patients who were electively hospitalized for carotid stenting from 2006 through 2011. The incidence of in-hospital mortality and morbidity was compared between patients who did and did not receive protamine after propensity score adjustment via 1:1 matching to reduce selection bias.

Of 6664 patients with carotid stenting treated at 193 hospitals, 556 (8%) received protamine on the day of the procedure. After matching by propensity score, patients who received protamine had a similar likelihood of stroke or transient ischemic attack (P=0.77), in-hospital mortality (P=0.12), discharge to long-term care (P=0.15), and access site complications (P=0.90) as compared with patients who did not receive protamine.

Protamine administration is not associated with additional risk of adverse events after carotid stenting.