Journal of Vascular Surgery
Volume 51, Issue 3 , Pages 559-564.e1 , March 2010

Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke

Presented at the Sixty-Third Annual Meeting of the Society for Vascular Surgery, Denver, Colorado, June 13, 2009.

  • David H. Stone, MD

      Affiliations

    • Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • Corresponding Author InformationReprint requests: David H. Stone, MD, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756
    • ,
  • Brian W. Nolan, MD

      Affiliations

    • Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • The Dartmouth Institute for Health Policy and Clinical Practice, Center for Leadership and Improvement, Worcester, Me
    • ,
  • Andres Schanzer, MD

      Affiliations

    • The University of Massachusetts Medical School, Mass, Me
    • ,
  • Philip P. Goodney, MD

      Affiliations

    • Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Robert A. Cambria, MD

      Affiliations

    • Eastern Maine Medical Center, Bangor, Me
    • ,
  • Donald S. Likosky, PhD

      Affiliations

    • The Dartmouth Institute for Health Policy and Clinical Practice, Center for Leadership and Improvement, Worcester, Me
    • ,
  • Daniel B. Walsh, MD

      Affiliations

    • Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Jack L. Cronenwett, MD

      Affiliations

    • Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Vascular Study Group of Northern New England

Received 12 August 2009 ,Accepted 2 October 2009.

References 

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  2. Weber CF, Friedl H, Hueppe M, Hintereder G, Schmitz-Rixen T, Zwissler B, et al. Impact of general versus local anesthesia on early postoperative cognitive dysfunction following carotid endarterectomy: GALA Study Subgroup Analysis. World J Surg. 2009;33:1526–1532
  3. Lutz HJ, Michael R, Gahl B, Savolainen H. Local versus general anaesthesia for carotid endarterectomy-improving the gold standard?. Eur J Vasc Endovasc Surg. 2008;36:145–149disussion 150-1
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  5. Naylor R, Hayes PD, Payne DA, Allroggen H, Steel S, Thompson MM, et al. Randomized trial of vein versus dacron patching during carotid endarterectomy: long-term results. J Vasc Surg. 2004;39:985–993discussion 993
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  7. Hans SS, Jareunpoon O. Prospective evaluation of electroencephalography, carotid artery stump pressure, and neurologic changes during 314 consecutive carotid endarterectomies performed in awake patients. J Vasc Surg. 2007;45:511–515
  8. Dellagrammaticas D, Lewis SC, Gough MJ. Is heparin reversal with protamine after carotid endarterectomy dangerous?. Eur J Vasc Endovasc Surg. 2008;36:41–44
  9. Levison JA, Faust GR, Halpern VJ, Theodoris A, Nathan I, Kline RG, et al. Relationship of protamine dosing with postoperative complications of carotid endarterectomy. Ann Vasc Surg. 1999;13:67–72
  10. Treiman RL, Cossman DV, Foran RF, Levin PM, Cohen JL, Wagner WH. The influence of neutralizing heparin after carotid endarterectomy on postoperative stroke and wound hematoma. J Vasc Surg. 1990;12:440–445discussion 445-6
  11. Nybo M, Madsen JS. Serious anaphylactic reactions due to protamine sulfate: a systematic literature review. Basic Clin Pharmacol Toxicol. 2008;103:192–196
  12. Fearn SJ, Parry AD, Picton AJ, Mortimer AJ, McCollum CN. Should heparin be reversed after carotid endarterectomy? (A randomised prospective trial). Eur J Vasc Endovasc Surg. 1997;13:394–397
  13. Mauney MC, Buchanan SA, Lawrence WA, Bishop A, Sinclair K, Daniel TM, et al. Stroke rate is markedly reduced after carotid endarterectomy by avoidance of protamine. J Vasc Surg. 1995;22:264–269discussion 269-70
  14. Goodney PP, Likosky DS, Cronenwett JL. Factors associated with stroke or death after carotid endarterectomy in Northern New England. J Vasc Surg. 2008;48:1139–1145
  15. Cronenwett JL, Likosky DS, Russell MT, Eldrup-Jorgensen J, Stanley AC, Nolan BW. A regional registry for quality assurance and improvement: the Vascular Study Group of Northern New England (VSGNNE). J Vasc Surg. 2007;46:1093–1101discussion 1101-2
  16. LaMuraglia GM, Brewster DC, Moncure AC, Dorer DJ, Stoner MC, Trehan SK, et al. Carotid endarterectomy at the millennium: what interventional therapy must match. Ann Surg. 2004;240:535–544discussion 544-6
  17. Engelter S, Lyrer P. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy. Cochrane Database Syst Rev. 2003;(3):CD001458
  18. Hamada Y, Kameyama Y, Narita H, Benson KT, Goto H. Protamine after heparin produces hypotension resulting from decreased sympathetic outflow secondary to increased nitric oxide in the central nervous system. Anesth Analg. 2005;100:33–37
  19. Welsby IJ, Newman MF, Phillips-Bute B, Messier RH, Kakkis ED, Stafford-Smith M. Hemodynamic changes after protamine administration: association with mortality after coronary artery bypass surgery. Anesthesiology. 2005;102:308–314
  20. Pretorius M, Scholl FG, McFarlane JA, Murphey LJ, Brown NJ. A pilot study indicating that bradykinin B2 receptor antagonism attenuates protamine-related hypotension after cardiopulmonary bypass. Clin Pharmacol Ther. 2005;78:477–485
  21. Kudoh O, Warabi K, Yamaguchi K, Ichinose M, Iizuka T, Inada E. [A case of anaphylactic shock in an elderly man following protamine sulfate administration during emergent off-pump coronary artery bypass grafting]. Masui. 2006;55:605–610

 Competition of interest: none.

 Additional material for this article may be found online at www.jvascsurg.org.

 The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.

PII: S0741-5214(09)02132-6

doi: 10.1016/j.jvs.2009.10.078

Journal of Vascular Surgery
Volume 51, Issue 3 , Pages 559-564.e1 , March 2010

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