Efficacy and safety of protamine sulfate following carotid artery stenting.

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine Pub Date : 2025-09-01 DOI:10.1016/j.carrev.2025.08.011

William Nicholson, Khaled I Alnahhal, John Han, Jacob Borenstein, Keivan Ranjbar, Stephanie D Talutis, Shivani Kumar, Payam Salehi

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引用次数: 0

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).

Conclusions: Protamine sulfate appears to be effective in reducing the bleeding complications in TCAR patients without increasing death or thrombotic complications. Its benefits are especially notable in females and those on ACE inhibitors, regardless of the CAS approach. Although protamine use in the TF-CAS cohort was associated with reduced all-cause mortality, it did not show an overall benefit in bleeding reduction. However, in TF-CAS, females and patients on ACE inhibitors did appear to benefit, supporting a more selective approach to its use.

查看原文本刊更多论文

颈动脉支架植入术后硫酸鱼精蛋白的疗效和安全性。

背景：硫酸鱼精蛋白用于降低颈动脉支架植入术（CAS）后出血风险，但其在个性化患者环境中的有效性仍未得到充分探讨。本研究旨在确定与CAS术后使用硫酸鱼精蛋白带来更大益处相关的因素。方法：回顾性分析血管质量倡议（VQI）数据（2016-2022），将接受CAS的患者分为经股动脉CAS （TF-CAS）组和经颈动脉重建术（TCAR）组。多变量分析用于确定围手术期出血并发症的预测因素，并比较鱼精蛋白组和无鱼精蛋白组之间的死亡率和血栓事件（心肌梗死（MI），卒中/短暂性脑缺血发作（TIA））的倾向评分匹配。结果：51473例患者（女性占36.9%）中，56.4%接受了TCAR（鱼精蛋白：85.6%；无鱼精蛋白：14.4%），43.6%接受了TF-CAS（鱼精蛋白：18.9%；无鱼精蛋白：81.1%）。鱼精蛋白显著减少了两组女性患者和ACE抑制剂患者的出血并发症。在TF-CAS组中，鱼精蛋白与较低的全因死亡率相关（7.9%比11.5%;P . 0.05）。在TCAR组中，鱼精蛋白具有相似的全因死亡率（7.7%对7.3%）、心肌梗死（0.4%对0.3%）和卒中/TIA（2.4%对2.9%;P < 0.05）。结论：硫酸鱼精蛋白可以有效减少TCAR患者的出血并发症，而不会增加死亡或血栓形成并发症。无论采用何种CAS方法，其益处在女性和ACE抑制剂患者中尤其显著。尽管在TF-CAS队列中使用鱼精蛋白与全因死亡率降低有关，但在减少出血方面并未显示出总体益处。然而，在TF-CAS中，女性和接受ACE抑制剂治疗的患者确实受益，支持更有选择性的使用方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.90%

发文量

687

审稿时长

36 days

期刊介绍： Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.