title: [Clinical observation of neutralizing heparin with protamine in carotid endarterectomy].
abstract: OBJECTIVE
  To evaluate the effects of administrating protamine to reverse heparin on intraoperative hemostatic time, postoperative drainage and postoperative complications in carotid endarterectomy.
  
  
  METHODS
  A retrospective cohort study of 125 cases of carotid endarterectomy was undertaken at Department of Vascular Surgery, Peking Union Medical Hospital in 2012. They were divided into 2 groups: heparin (H group) and heparin + intra-operative administration of protamine (H+P group). Their medical history, preoperative clinical findings, intraoperative hemostatic time, postoperative drainage volume and complications were compared between two groups and statistically analyzed.
  
  
  RESULTS
  Fifty cases received heparin alone and 75 cases had heparin reversal with protamine. Drainage volumes at Day 1 postoperation were less in H+P group than those in H group with statistically significant difference ((14 ± 13) vs (19 ± 12) ml, P = 0.038). And total postoperative drainage volumes were less in H+P group with statistical significant difference ((20 ± 17) vs (26 ± 15) ml, P = 0.035). Intraoperative hemostatic time was less in H+P group than that in H group with statistical significant difference ((30 ± 11) vs (36 ± 11) min, P = 0.030). There was no mortality. Only one case was re-operated for cervical hematoma. Cerebral ischemic symptoms of one patient in the H+P group became worse postoperatively and recovered after conservative medical treatment.
  
  
  CONCLUSIONS
  During carotid endarterectomy, the application of protamine may significantly decrease intraoperative hemostatic time and postoperative wound drainage. And protamine has no effect of increasing the risks of perioperative stroke.
authors.affiliation: Department of Vascular Surgery, Peking Union Medical Hospital, Beijing 100730, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Vascular Surgery, Peking Union Medical Hospital, Beijing 100730, China.
authors.forename: Yue-xin
authors.initials: YX
authors.lastname: Chen
authors.affiliation: Department of Vascular Surgery, Peking Union Medical Hospital, Beijing 100730, China.
authors.forename: Leng
authors.initials: L
authors.lastname: Ni
authors.affiliation: Department of Vascular Surgery, Peking Union Medical Hospital, Beijing 100730, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Vascular Surgery, Peking Union Medical Hospital, Beijing 100730, China. Email: liucw@vip.sina.com.
authors.forename: Chang-wei
authors.initials: CW
authors.lastname: Liu
mesh_terms: D000368:Aged; D004322:Drainage; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011479:Protamines / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011479:Protamines; D006493:Heparin