title: Relationship of protamine dosing with postoperative complications of carotid endarterectomy.
abstract: Protamine sulfate (PS) neutralization of heparin (HEP) given during carotid endarterectomy (CEA) has been previously associated with an increased postoperative stroke rate. Dosing regimens of PS have varied in previous studies. The accuracy of PS dosing and its effect on postoperative complications was analyzed. The medical records of all patients undergoing elective CEAs from January 1993 to June 1996 in our institution were reviewed. A hematoma was defined as either an event requiring return to the operating room or when repeatedly identified in the medical record. The accuracy of dosing PS was determined utilizing a formula calculating the logarithmic exponential decay of HEP, which determined the residual HEP at the time of PS dosing. An ideal PS dose was then calculated and compared to the dose given. Statistical analyses was performed using a Fisher's exact test as well as the Student's t-test. Four hundred-seven CEAs were performed in 365 patients. There were 10/407 (2.5%) postoperative strokes (STROKE) and 11/407 (2.7%) hematomas, 3 of which required reoperation. Results indicate that (1) the administration of PS significantly reduced the incidence of postoperative hematoma; (2) there appears to be an association between the administration of PS and STROKE; (3) the inaccuracy in dosing PS appears to be based on a decision to dose PS to the total HEP given rather than the residual HEP on board at the time of neutralization. The effect of PS overdosing is unclear, but it may play a role in STROKE.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Levison
authors.forename: G R
authors.initials: GR
authors.lastname: Faust
authors.forename: V J
authors.initials: VJ
authors.lastname: Halpern
authors.forename: A
authors.initials: A
authors.lastname: Theodoris
authors.forename: I
authors.initials: I
authors.lastname: Nathan
authors.forename: R G
authors.initials: RG
authors.lastname: Kline
authors.forename: J R
authors.initials: JR
authors.lastname: Cohen
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D016894:Endarterectomy, Carotid; D005260:Female; D006494:Heparin Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011479:Protamines / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D006494:Heparin Antagonists; D011479:Protamines