Administration of protamine after coronary stent deployment.
BACKGROUND
Prompt reversal of anticoagulation by protamine administration could be an important therapeutic option to treat serious procedural complications such as vessel rupture or major bleeding from the puncture site during coronary stent implantation. However, this therapeutic option is rarely used because of the possible risk of stent thrombosis.


METHODS
We retrospectively analyzed the incidence of acute and subacute stent thrombosis and vascular complications in 90 patients who received protamine (protamine group) and 1763 patients who did not receive protamine (control group) after successful coronary stent implantation. The 2 groups were matched for clinical, angiographic, and procedure characteristics.


RESULTS
No patients in the protamine group had adverse effects such as hypotension or vascular collapse during protamine administration. Acute stent thrombosis did not occur in any protamine group patient but did occur in 12 patients in the control group (0.7%) (P =.47). Subacute stent thrombosis occurred in 2 patients in the protamine group (2.1%) and in 15 in the control group (0.8%) (P =.20). By logistic regression analysis, protamine was not a determinant of stent thrombosis.


CONCLUSIONS
Reversal of anticoagulation by protamine after stent implantation does not predispose to stent thrombosis. This result has important clinical consequences because it allows the use of protamine in the treatment of coronary perforation and serious bleeding complications that may occur during coronary stent deployment.
Briguori
C
C
Centro Cuore Columbus, Milan, Italy.
Di Mario
C
C
De Gregorio
J
J
Sheiban
I
I
Vaghetti
M
M
Colombo
A
A
D000368:Aged; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006494:Heparin Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011479:Protamines / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
D006494:Heparin Antagonists; D011479:Protamines