The use of protamine after radiofrequency catheter ablation: a pilot study.
OBJECTIVE
Evaluate the effect of administering intravenous protamine immediately post-radiofrequency catheter ablation (RFCA) on thrombotic and bleeding complications in heparinized patients.


METHODS
Heparinized patients that had RFCA for atrial or ventricular arrhythmias at our institution between January 2001 and March 2006 and had a complete data set were included in this cohort evaluation. Patients receiving at least one dose of protamine within 15 min of RFCA were deemed the prophylactic group while those not receiving protamine within 15 min were the control group. Thrombotic (cerebrovascular event, transient ischemic attack, pulmonary embolism, deep vein thrombosis, or myocardial infarction) and bleeding events (blood loss requiring transfusion, hematoma requiring intervention, or intracranial hemorrhage) were compared between groups.


RESULTS
Overall, 158 patients (74% male, 55 +/- 13.5) met inclusion criteria. Of these, 73.4% received prophylactic protamine (average dose = 39 mg +/- 17). Only one patient (0.9%) in the prophylactic protamine group and zero patients in the control group experienced a thrombotic event (p > 0.99). Only two patients (1.7%) in the protamine group (n = 2 blood transfusions) and zero patients in the control group experienced bleeding events (p = 0.839).


CONCLUSIONS
Administering prophylactic intravenous protamine to allow for quicker catheter removal following RFCA in heparinized patients did not markedly impact thrombotic or bleeding complication rates in our population. The perceived benefit in our institution to protamine administration in this population is a reduction in postoperative patient immobilization and discomfort, reduced PACU nursing care, and earlier time to discharge. Given the low rate of thrombotic and bleeding events, a study of several thousand patients would be needed to fully evaluate the impact on these events.
Patel
Aarti A
AA
Division of Cardiology, Hartford Hospital, Hartford, CT 06102, USA.
Clyne
Christopher A
CA
Henyan
Nickole N
NN
White
C Michael
CM
Zembrowski
Bryan F
BF
Migeed
Magdy
M
Yarlagadda
Ravi
R
Kluger
Jeffrey
J
Coleman
Craig I
CI
D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017115:Catheter Ablation; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006494:Heparin Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011479:Protamines / Q000627:therapeutic use*; D017180:Tachycardia, Ventricular / Q000628:therapy*; D013927:Thrombosis / Q000517:prevention & control; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin