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Protamine Reduces Bleeding Complications without Increasing the Risk of Stroke after Carotid Endarterectomy: A
J D Kakisis1, C N Antonopoulos1, K G Moulakakis1
1Department of Vascular Surgery, "Attikon" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Summary
Heparin reversal with protamine after carotid endarterectomy (CEA) significantly reduces wound hematoma risk without increasing stroke rates. Further research is recommended to strengthen evidence on protamine
Area of Science:
- Vascular Surgery
- Anesthesiology
- Clinical Pharmacology
Background:
- Carotid endarterectomy (CEA) is a procedure to prevent stroke.
- Heparin is commonly used during CEA, requiring reversal with protamine.
- The safety and efficacy of protamine for heparin reversal in CEA are debated.
Purpose of the Study:
- To evaluate the safety and efficacy of heparin reversal with protamine after CEA.
- To summarize available data from randomized and non-randomized studies on protamine use in CEA.
Main Methods:
- A meta-analysis of seven studies involving 3,817 patients receiving protamine and 6,070 not receiving protamine after CEA.
- Pooled odds ratios (ORs) calculated for stroke and wound hematoma.
- Meta-regression analysis performed to assess influencing factors.
Main Results:
- A statistically significant reduction in wound hematoma requiring re-operation was observed with protamine (OR, 0.42; 95% CI, 0.22-0.80).
- No significant difference in stroke rates was found between groups receiving or not receiving protamine (OR, 0.71; 95% CI, 0.49-1.03).
- Meta-regression did not reveal significant effects from patient or procedure-related predictors.
Conclusions:
- Heparin reversal with protamine appears to reduce wound hematoma risk after CEA without increasing stroke risk.
- Limitations of the current meta-analysis necessitate further studies to enhance the evidence level.
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