Reversal of Heparin Anticoagulation by Protamine after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Objective: To systematically evaluate the safety and efficacy of protamine in reversing heparin anticoagulation after percutaneous coronary intervention (PCI). Methods: Systematic searches were conducted in PubMed and the Cochrane Library databases to identify relevant literature on protamine reversing heparin anticoagulation after PCI. The search period was set from the database establishment to 2023, and the references of included literature were also traced. The researchers screened the literature according to the inclusion and exclusion criteria and extracted the valid data for quality evaluation. Meta-analysis was performed using Stata 16.0 software. Results: A total of 9 articles were included in this study. The Meta-analysis results showed that using protamine after PCI significantly reduced the incidence of hematoma [RR = 0.49, 95% CI: 0.37~0.66] and the risk of in-stent thrombosis [RR = 0.34, 95% CI: 0.14~0.83] in patients, but had no significant effect on the total mortality [RR = 0.98, 95% CI: 0.59~1.63], myocardial infarction, and the incidence of hypotension [RR = 0.98, 95% CI: 0.86~1.13]. Conclusion: This study confirmed that using protamine to reverse heparin anticoagulation after PCI can reduce the incidence of hematoma and in-stent thrombosis in patients after PCI, and does not increase the mortality, myocardial infarction, and the incidence of hypotension in patients, demonstrating certain safety and efficacy.