title: Low-dose heparin appears safe and can eliminate protamine use for carotid endarterectomy.
abstract: OBJECTIVE
  To determine the morbidity associated with carotid endarterectomy (CEA) when low doses of heparin (30 U/kg) are used for anticoagulation. This technique eliminates the need for protamine and its potentially deleterious effects on some patients.
  
  
  METHODS
  A retrospective chart review.
  
  
  METHODS
  A large academic medical center.
  
  
  METHODS
  The records of 420 consecutive CEAs in 337 patients (83 bilateral procedures).
  
  
  METHODS
  None.
  
  
  RESULTS
  The amount of heparin used was less than that used in most reported studies. Eighty-two percent of patients received only 2,000 U of heparin for their entire operation (range, 500 to 3,000 U). Complication rates were low. Neurologic complications included a 0.95% incidence of nonfatal stroke and a 2.1% incidence of transient neurologic deficits that resolved in the first day. There was no mortality. The wounds were described in the postoperative period as dry (96%), swollen (3%), or bloody (1%). No patients received protamine.
  
  
  CONCLUSIONS
  The use of 5 to 10,000 U of heparin will provide anticoagulation for more than an hour. In CEA surgery, anticoagulation for this duration is often unnecessary. A smaller dose of heparin (30 U/kg) can provide adequate anticoagulation for this procedure while eliminating the potentially deleterious effects of protamine use. No additional morbidity was attributed to this technique.
authors.affiliation: Department of Anesthesiology, Albany Medical College, NY 12208, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Groudine
authors.forename: Y
authors.initials: Y
authors.lastname: Sakawi
authors.forename: M K
authors.initials: MK
authors.lastname: Patel
authors.forename: C
authors.initials: C
authors.lastname: Darling
authors.forename: A
authors.initials: A
authors.lastname: Abdel-Raouf
authors.forename: P
authors.initials: P
authors.lastname: Paty
authors.forename: P D
authors.initials: PD
authors.lastname: Lumb
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D007902:Length of Stay; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011479:Protamines / Q000008:administration & dosage; D012189:Retrospective Studies; D012449:Safety
chemical_list: D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin