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Low-dose heparin appears safe and can eliminate protamine use for carotid endarterectomy
S B Groudine1, Y Sakawi, M K Patel
1Department of Anesthesiology, Albany Medical College, NY 12208, USA.
Objective:
To determine the morbidity associated with carotid endarterectomy (CEA) when low doses of heparin (30 U/kg) are used for anticoagulation. This technique eliminates the need for protamine and its potentially deleterious effects on some patients.
Design:
A retrospective chart review.
Setting:
A large academic medical center.
Participants:
The records of 420 consecutive CEAs in 337 patients (83 bilateral procedures).
Interventions:
None.
Measurements And Main Results:
The amount of heparin used was less than that used in most reported studies. Eighty-two percent of patients received only 2,000 U of heparin for their entire operation (range, 500 to 3,000 U). Complication rates were low. Neurologic complications included a 0.95% incidence of nonfatal stroke and a 2.1% incidence of transient neurologic deficits that resolved in the first day. There was no mortality. The wounds were described in the postoperative period as dry (96%), swollen (3%), or bloody (1%). No patients received protamine.
Conclusion:
The use of 5 to 10,000 U of heparin will provide anticoagulation for more than an hour. In CEA surgery, anticoagulation for this duration is often unnecessary. A smaller dose of heparin (30 U/kg) can provide adequate anticoagulation for this procedure while eliminating the potentially deleterious effects of protamine use. No additional morbidity was attributed to this technique.