Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR – a multicentre experience

Abstract Background Despite major advances, transcatheter aortic valve replacement (TAVR) is associated with procedure-related vascular and bleeding complications, that have a significant impact on mortality. A recently published study has shown heparin antagonization using protamine resulted in significantly lower rates of serious events patients undergoing TAVR as compared to those without reversal. However, the optimal protamine-to-heparin dosing ratio prevent complications increasing ischemic unknown. Accordingly, daily clinical practice varies between selective routine administration different ratios. Purpose The aim this observational multicentre was compare safety efficacy two ratios for prevention after TAVR. Methods included 1446 TAVR, whom 623 (43.1%) received partial 823 (56.9%) full (0.4–0.6 mg versus 0.9–1.0 protamine/100 units heparin). indication or left discretion operator, who made decision according patient's individual thrombotic risk. primary endpoint composite 30-day mortality, life-threatening bleeding. Safety endpoints stroke myocardial infarction at 30 days. Results overall population had mean age 81.1±6.0 years; 47.9% were female gender. baseline characteristics well balanced groups. Full reversal (5.6 vs. 10.4%, p<0.01), mainly driven by (0.5 vs 1.6%, p=0.05) (3.2 7.5%, p<0.01). incidence (3.5 presented Figure 1. post-interventional drop hemoglobin level need red-blood-cell transfusion receiving (1.5±1.2 1.7±1.2 g/dl, p<0.01; 10.4 15.9%, p<0.01, respectively). Regarding endpoints, no differences observed groups (2.2 2.6%, p=0.73 0.2 0.4%, p=0.64, Multivariate regression analyses revealed (OR: 0.43 [95% CI: 0.24–0.81], p<0.01) independently end point Conclusion occurrence low comparable both Funding Acknowledgement Type funding sources: Public grant(s) – National budget only. Main source(s): Funded Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).