Immediate protamine administration and sheath removal following percutaneous coronary intervention: a prospective study of 429 patients.
We tested the approach of reversing anticoagulation following PCI and immediate sheath removal in 429 consecutive patients. On completion of the PCI, protamine was administered, and the vascular sheath was immediately removed. Stents were used in 364 patients (85%) and GP IIb/IIIa inhibitors were used in 52 patients (12%). Time to achieve hemostasis was 30 +/- 17 min. Minor groin bleeding occurred in six patients. One patient required repair of femoral pseudoaneurysm. Mean creatine kinase at 8 and 16 hr post-PCI were 129 +/- 35 and 145 +/- 32 units, respectively. Creatine kinase rose to > 3 times normal in 12 out of 350 patients (3.4%). Prior to 48 hr, eight patients (1.9%) required emergency PCI or coronary bypass surgery. Follow-up at 30 days observed no deaths and only three target vessel revascularizations (0.7%). In conclusion, immediate reversal of anticoagulation and sheath removal after PCI is safe and feasible.
Section of Cardiology, University of Manitoba Health Sciences Center and St. Boniface Hospital, Winnipeg, Manitoba, Canada. jducas@cc.umanitoba.ca
John
J
Ducas
Michael C Y
MC
Chan
Anthony
A
Miller
Tarek
T
Kashour
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000517:prevention & control; D006488:Hemostasis, Surgical; D006494:Heparin Antagonists / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage*; D011677:Punctures; D015607:Stents; D013988:Ticlopidine / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006494:Heparin Antagonists; D011479:Protamines; D013988:Ticlopidine