SynthesisEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery2016
Protamine Reduces Bleeding Complications without Increasing the Risk of Stroke after Carotid Endarterectomy: A Meta-analysis.
Synthesis in European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07288164 (Comparison of Operative and Early Postoperative Outcomes Between Eversion and Conventional Techniques in Carotid Endarterectomy), which is not on this map. Cited by 13 papers, 1 of them a synthesis 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.
The trial behind it
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.
Comparison of Operative and Early Postoperative Outcomes Between Eversion and Conventional Techniques in Carotid Endarterectomy
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Protamine sulphate for heparin reversal in percutaneous cardiac interventions: a systematic review and meta-analysis of randomized controlled trials.Naunyn-Schmiedeberg's archives of pharmacology · 2025Pooled it
- Re-Thinking Antithrombotic Strategies in Non-Cardiac Arterial Procedures: Time for Standardisation?EJVES vascular forum · 2025Article
- Strategies for Antithrombotic Management During Non-cardiac Arterial Procedures: Results of the International ACTION Survey.EJVES vascular forum · 2025Article
- Evaluation of Aneurysm Cases Undergoing Surgery at a Tertiary Center in Iran: A 22-year Retrospective Study.Health science reports · 2025Article
- An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis.Journal of vascular surgery · 2024Review
- Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease.Jornal vascular brasileiro · 2024Article
- A Stepwise Haemostasis Intraoperative Protocol Driven Reduction of Haematoma Rate Following Symptomatic Carotidendarterectomy.Vascular and endovascular surgery · 2023Article
- Intravenous thrombolysis in acute ischemic stroke after antagonization of unfractionated heparin with protamine: case series and systematic review of literature.Therapeutic advances in neurological disorders · 2023Article
- Anesthetic management of carotid endarterectomy: an update from Italian guidelines.Journal of anesthesia, analgesia and critical care · 2022Article
- 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
- Surgical Technique for Carotid Endarterectomy: Current Methods and Problems.Neurologia medico-chirurgica · 2020Review
- Haematomas after carotid endarterectomy can be reduced by direct pressure to the neck postoperatively.Annals of the Royal College of Surgeons of England · 2018Article
- Competitive Antagonism of Anesthetic Action at the γ-Aminobutyric Acid Type A Receptor by a Novel Etomidate Analog with Low Intrinsic Efficacy.Anesthesiology · 2017Article
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe aim was to evaluate the safety and efficacy of heparin reversal with protamine after completion of carotid endarterectomy (CEA), summarising the available data from both randomised and non-randomised studies.
methodsThe study was a meta-analysis. Pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated for the outcomes of stroke and wound haematoma among patients receiving or not receiving protamine after CEA. Meta-regression analysis was performed to examine whether the documented differences were modified by potentially meaningful patient related or procedure related predictors, namely publication year, general anesthesia used, number of patients treated, mean age (years), males, neurological symptoms, use of patch, and use of shunt.
resultsSeven studies were included in the meta-analysis reporting on 3,817 patients receiving protamine after CEA and 6,070 patients not receiving protamine for heparin reversal. Only one study was randomised. A statistically significant reduction in wound haematoma requiring re-operation was recorded after heparin reversal with protamine in patients undergoing CEA (OR, 0.42, 95% CI, 0.22-0.80, p = .008). In contrast, no significant difference was observed in stroke rates between groups of patients that received and did not receive protamine (OR, 0.71, 95% CI, 0.49-1.03, p = .07). Meta-regression analysis did not reveal any significant effect mediated by the modifiers examined.
conclusionOn the basis of the available data, heparin reversal with protamine seems to reduce the risk of wound haematoma, without increasing the risk of procedural stroke. However, taking into account the limitations of the analysis, further studies are needed to increase the level of evidence provided by the current meta-analysis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.