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Published on: July 9, 2020
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Protamine use in transcarotid arterial revascularization
John J Kanitra1, Rebekah L Bjorklund2, David J Clausen1
1Department of Surgery, 21928Ascension St John Hospital, Detroit, MI, USA.
Vascular
|January 18, 2022
Summary
In transcarotid arterial revascularization (TCAR), a near 1:1 protamine to heparin ratio was used for reversal. Lower protamine doses did not increase bleeding complications, suggesting potential for reduced use during shortages.
Area of Science:
- Vascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Heparin reversal with protamine is standard in transcarotid arterial revascularization (TCAR).
- Optimal protamine dosing for heparin reversal in TCAR remains unevaluated.
- Previous literature suggests reduced bleeding without increased stroke or death.
Purpose of the Study:
- To evaluate the institutional experience with intraoperative heparin reversal using protamine in TCAR procedures.
- To assess the protamine to heparin dose ratio utilized in TCAR.
- To investigate the association between protamine/heparin ratio and postoperative complications.
Main Methods:
- Single-center, retrospective, observational study.
- Inclusion of adult patients undergoing TCAR between September 2019 and April 2021.
- Data collection from Vascular Quality Initiative and chart review for heparin/protamine doses.
- Multivariate logistic regression to analyze protamine/heparin ratio associations.
Main Results:
- Sixty-two patients were analyzed with an average protamine/heparin ratio of 0.96 ± 0.12 mg/U.
- No postoperative bleeding occurred in patients with a protamine/heparin ratio > 0.8 mg/U.
- Incidence of bradycardia (32.3%) and hypotension (35%) was observed, with no correlation to the protamine/heparin ratio.
- Zero 30-day myocardial infarction, stroke, or death events were recorded.
Conclusions:
- A near 1:1 protamine/heparin ratio is commonly used for heparin reversal in TCAR.
- Lower protamine doses (ratio > 0.8 mg/U) were not associated with increased bleeding complications.
- Further large-scale studies are warranted to explore reduced protamine dosing, especially during shortages.
