ArticleJournal of vascular surgery2010
Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke.
Article in Journal of vascular surgery, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 4 syntheses or guidelines pooled it, 73 citations in OpenAlex.
- Pooled it
- American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy.Blood advances · 2018Guideline
- Use of Protamine for Anticoagulation During Carotid Endarterectomy: A Meta-analysis.JAMA surgery · 2016Pooled it
- Safety and efficacy of protamine after transcatheter aortic valve replacement.Indian heart journalPooled it
- Efficacy and Safety of Low-Dose Protamine in Reducing Bleeding Complications during TAVI: A Propensity-Matched Comparison.Journal of clinical medicine · 2023Article
- Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR-A multicenter experience.Clinical cardiology · 2023Article
- A Meta-Analysis of Using Protamine for Reducing the Risk of Hemorrhage During Carotid Recanalization: Direct Comparisons of Post-operative Complications.Frontiers in pharmacology · 2022Review
- Risk factors associated with 30-day hospital readmission after carotid endarterectomy.Vascular · 2021Article
- Neuroprotective Cationic Arginine-Rich Peptides (CARPs): An Assessment of Their Clinical Safety.Drug safety · 2020Review
- Safe carotid endarterectomy: "one fits all strategy".Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2020Article
- Variation in Anticoagulation Practices in the Congenital Cardiac Catheterization Lab: Results of a Multinational PICES Survey.Pediatric cardiology · 2019Article
- Regional variation in patient selection and treatment for carotid artery disease in the Vascular Quality Initiative.Journal of vascular surgery · 2017Article
- Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy.Journal of vascular surgery · 2016Article
- Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study.Journal of vascular surgery · 2016Observational
- A comparison of results with eversion versus conventional carotid endarterectomy from the Vascular Quality Initiative and the Mid-America Vascular Study Group.Journal of vascular surgery · 2015Article
- Using protamine can significantly reduce the incidence of bleeding complications after carotid endarterectomy without increasing the risk of ischemic cerebral events.World journal of surgery · 2014Article
- The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality.Journal of vascular surgery · 2014Observational
- Shared quality data are associated with increased protamine use and reduced bleeding complications after carotid endarterectomy in the Vascular Study Group of New England.Journal of vascular surgery · 2013Article
- Optimal strategies including use of newer anticoagulants for prevention of stroke and bleeding complications before, during, and after catheter ablation of atrial fibrillation and atrial flutter.Current treatment options in cardiovascular medicine · 2013Article
- Intraoperative use of dextran is associated with cardiac complications after carotid endarterectomy.Journal of vascular surgery · 2013Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesControversy persists regarding the use of protamine during carotid endarterectomy (CEA) based on prior conflicting reports documenting both reduced bleeding as well as increased stroke risk. The purpose of this study was to determine the effect of protamine reversal of heparin anticoagulation on the outcome of CEA in a contemporary multistate registry.
methodsWe reviewed a prospective regional registry of 4587 CEAs in 4311 patients performed by 66 surgeons from 11 centers in Northern New England from 2003-2008. Protamine use varied by surgeon (38% routine use, 44% rare use, 18% selective use). Endpoints were postoperative bleeding requiring reoperation as well as potential thrombotic complications, including stroke, death, and myocardial infarction (MI). Predictors of endpoints were determined by multivariate logistic regression after associated variables were identified by univariate analysis.
resultsOf the 4587 CEAs performed, 46% utilized protamine, while 54% did not. Fourteen patients (0.64%) in the protamine-treated group required reoperation for bleeding compared with 42 patients (1.66%) in the untreated cohort (P = .001). Protamine use did not affect the rate of MI (1.1% vs 0.91%, P = .51), stroke (0.78% vs 1.15%, P = .2), or death (0.23% vs 0.32%, P = .57) between treated and untreated patients, respectively. By multivariate analysis, protamine (odds ratio [OR] 0.32, 95% confidence interval [CI], 0.17-0.63; P = .001) and patch angioplasty (OR 0.46, 95% CI, 0.26-0.81; P = .007) were independently associated with diminished reoperation for bleeding. A single center was associated with a significantly higher rate of reoperation for bleeding (OR 6.47, 95% CI, 3.02-13.9; P < .001). Independent of protamine use, consequences of reoperation for bleeding were significant, with a four-fold increase in MI, a seven-fold increase in stroke, and a 30-fold increase in death.
conclusionProtamine reduced serious bleeding requiring reoperation during CEA without increasing the risk of MI, stroke, or death, in this large, contemporary registry. In light of significant complications referable to bleeding, liberal use of protamine during CEA appears warranted.
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