[Clinical observation of neutralizing heparin with protamine in carotid endarterectomy]

To evaluate the effects of administrating protamine to reverse heparin on intraoperative hemostatic time, postoperative drainage and postoperative complications in carotid endarterectomy.

A retrospective cohort study of 125 cases of carotid endarterectomy was undertaken at Department of Vascular Surgery, Peking Union Medical Hospital in 2012. They were divided into 2 groups: heparin (H group) and heparin + intra-operative administration of protamine (H+P group). Their medical history, preoperative clinical findings, intraoperative hemostatic time, postoperative drainage volume and complications were compared between two groups and statistically analyzed.

Fifty cases received heparin alone and 75 cases had heparin reversal with protamine. Drainage volumes at Day 1 postoperation were less in H+P group than those in H group with statistically significant difference ((14 ± 13) vs (19 ± 12) ml, P = 0.038). And total postoperative drainage volumes were less in H+P group with statistical significant difference ((20 ± 17) vs (26 ± 15) ml, P = 0.035). Intraoperative hemostatic time was less in H+P group than that in H group with statistical significant difference ((30 ± 11) vs (36 ± 11) min, P = 0.030). There was no mortality. Only one case was re-operated for cervical hematoma. Cerebral ischemic symptoms of one patient in the H+P group became worse postoperatively and recovered after conservative medical treatment.

During carotid endarterectomy, the application of protamine may significantly decrease intraoperative hemostatic time and postoperative wound drainage. And protamine has no effect of increasing the risks of perioperative stroke.