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. 2022 May 10;22(1):207.
doi: 10.1186/s12872-022-02650-5.

Safety and efficacy of immediate heparin reversal with protamine after complex percutaneous coronary intervention

Jin Hee Choi  1 , Kook Jin Chun  2 , Soon Myung Jung  1 , Soo Yong Lee  1 , Min Ku Chon  1 , Sang Hyun Lee  1 , Ki Won Hwang  1 , Jeong Su Kim  1 , Yong-Hyun Park  1 , June Hong Kim  1
Affiliations

Safety and efficacy of immediate heparin reversal with protamine after complex percutaneous coronary intervention

Jin Hee Choi et al. BMC Cardiovasc Disord. .

Abstract

Background: Compared to simple percutaneous coronary intervention (PCI), complex PCI is associated with higher bleeding and thrombotic risk. No previous study has evaluated the use of protamine after PCI with contemporary technologies. This study aimed to evaluate the safety and efficacy of manual compression with and without protamine after transfemoral complex PCI.

Methods: We retrospectively analyzed 160 patients (protamine group, n = 92; non-protamine group, n = 68) who underwent complex PCI via the femoral artery. The primary outcome was a composite of in-hospital death, myocardial infarction, stent thrombosis, stroke/systemic embolism, bleeding requiring blood transfusion, and vascular access complications.

Results: The primary outcome was significantly lower in the protamine group than in the non-protamine group (4.3% vs. 17.6%; p = 0.006). This was driven mainly by the lower incidences of hematoma in the protamine group (3.3% vs. 13.2%, p = 0.020). Furthermore, the protamine group had a significantly shorter hospital stay than the non-protamine group (4.8 ± 3.7 days vs. 8.4 ± 8.3 days, p = 0.001). While > 90% of the patients had acute coronary syndrome, there were no incidences of myocardial infarction or stent thrombosis in either group.

Conclusions: Among patients who underwent complex PCI via transfemoral access, immediate protamine administration was associated with a significantly lower rate of vascular access complications, especially hematoma, and shorter hospital stay than no protamine administration.

Keywords: Anticoagulant; Bleeding; Percutaneous coronary intervention; Protamine.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Clinical outcomes of the patients according to protamine administration. Primary outcome = a composite of in-hospital death, myocardial infarction, stent thrombosis, stroke/systemic embolism, bleeding requiring blood transfusion, and vascular access complications
Fig. 2
Fig. 2
Forest plot of multivariate logistic regression analysis for predictors associated with the primary outcome. CI confidence interval, PCI percutaneous coronary intervention
See this image and copyright information in PMC

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