Efficacy and safety of protamine sulfate following carotid artery stenting
Abstract
Background
protamine sulfate is used to reduce bleeding risk after Carotid Artery Stenting (CAS), but its efficacy in personalized patient settings remains underexplored. This study aims to identify factors associated with greater benefits from protamine sulfate following CAS.
Methods
A retrospective review of Vascular Quality Initiative (VQI) data (2016–2022) identified patients undergoing CAS, divided into Transfemoral CAS (TF-CAS) and Transcarotid artery revascularization (TCAR) groups. Multivariate analysis used to identify perioperative predictors of bleeding complications, and propensity score matching compared rates of death and thrombotic events (myocardial infarction (MI), stroke/transient ischemic attack (TIA)) between protamine and no protamine groups.
Results
Among 51,473 patients (36.9 % females), 56.4 % underwent TCAR (Protamine: 85.6 %; No protamine: 14.4 %), and 43.6 % underwent TF-CAS (Protamine: 18.9 %; No protamine: 81.1 %). Protamine significantly reduced bleeding complications in female patients and those on ACE inhibitors in both groups. In the TF-CAS group, protamine was associated with lower all-cause mortality (7.9 % vs. 11.5 %; P < .001) without an increase in MI (0.5 % vs. 0.9 %) or stroke/TIA (2.8 % vs. 2.9 %; P > .05). In the TCAR group, protamine had similar rates of all-cause mortality (7.7 % vs. 7.3 %), MI (0.4 % vs. 0.3 %), and stroke/TIA (2.4 % vs. 2.9 %; P > .05).