title: Stroke rate is markedly reduced after carotid endarterectomy by avoidance of protamine.
abstract: OBJECTIVE
  Postoperative neurologic injury remains a significant risk of carotid endarterectomy. Mechanisms include embolization of debris and formation of thrombus on the newly endarterectomized surface. We hypothesized that the risk of postoperative neurologic injury would be lower in those patients who did not receive protamine for reversal of heparin anticoagulation.
  
  
  METHODS
  We reviewed 348 consecutive primary carotid endarterectomies performed since January 1, 1986, to determine the relationship between surgical outcomes and reversal of heparin anticoagulation. Patients undergoing additional simultaneous cardiovascular procedures were excluded. One hundred ninety-three patients received protamine after completion of the endarterectomy. The remaining 155 patients did not receive any protamine.
  
  
  RESULTS
  All patients in both groups survived to discharge. There were no strokes in those patients who did not receive any protamine; however, the stroke rate in the protamine group was 2.6% (5 of 193), p < 0.045. The incidence of hematoma requiring reexploration was 1.0% (2 of 193) and 1.9% (3 of 155) in the protamine and no-protamine groups, respectively (p = NS). Intraoperative shunting was used more frequently in the no-protamine group (84% vs 67%, p < 0.001), and patch angioplasty was performed more frequently in the protamine group (35% vs 15%, p < 0.001). However, neither shunting nor patching significantly influenced stroke rates.
  
  
  CONCLUSIONS
  We conclude that carotid endarterectomy without reversal of heparin anticoagulation is associated with a reduced postoperative stroke rate without a significant increase in morbidity rates.
authors.affiliation: University of Virginia School of Medicine, Section of Vascular Surgery, Charlottesville 22908, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Mauney
authors.forename: S A
authors.initials: SA
authors.lastname: Buchanan
authors.forename: W A
authors.initials: WA
authors.lastname: Lawrence
authors.forename: A
authors.initials: A
authors.lastname: Bishop
authors.forename: K
authors.initials: K
authors.lastname: Sinclair
authors.forename: T M
authors.initials: TM
authors.lastname: Daniel
authors.forename: C G
authors.initials: CG
authors.lastname: Tribble
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000517:prevention & control; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011479:Protamines / Q000008:administration & dosage*
chemical_list: D011479:Protamines; D006493:Heparin