Why the study?
Complex PCI carries higher bleeding and thrombotic risks than simple PCI, but no previous study had evaluated protamine use after PCI with contemporary technologies.
Does immediate heparin reversal with protamine reduce adverse clinical events and vascular access complications in patients undergoing complex transfemoral PCI?
Does immediate heparin reversal with protamine reduce adverse clinical events and vascular access complications in patients undergoing complex transfemoral PCI?
Immediate heparin reversal with protamine after transfemoral complex PCI significantly reduces vascular access complications and shortens hospital stay without increasing the risk of stent thrombosis or myocardial infarction.
Protamine use was associated with fewer access complications after complex transfemoral PCI; hypothesis-generating and requires randomized confirmation before practice change.
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.
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Choi et al. (2022) studied this question.
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