Protamine Sulfate Following Carotid Artery Stenting: Does the Patient’s Gender Matter?

Protamine sulfate can be administrated to decrease the risk of bleeding after carotid artery stenting (CAS) procedure. Although a few studies reported data regarding efficacy and safety protamine, existing literature assessing its impact under more personalized patient circumstances is limited. Therefore, in this study, we aimed identify potential factors where patients are likely benefit from protamine CAS procedures. A retrospective review Vascular Quality Initiative between 2016 2022 all who underwent procedures was performed. The were divided into two groups based on surgical approach: transfemoral (TF-CAS) transcarotid revascularization (TCAR). multivariate model conducted perioperative predictors complications each cohort. In addition, propensity score matching performed compare rates thrombotic events vs no both cohorts. total 61,686 identified; 36.6% female. Approximately 53% TCAR (protamine: 85.6%; protamine: 14.4%), whereas TF-CAS 46.8% 18.9%; 81.1%). use associated with decreased (0.26 [0.2-0.3]; P < .001) but not (1.06 [0.8-1.3]; = .6164). However, beneficial apparent among female regardless approach (Table). significant increase noted (protamine death, 7.9% 11.5%; myocardial infarction, 0.5% 0.9%; stroke/transient ischemic attack, 2.8% 2.9%; > .05 for all, except death 7.7% 7.3%; 0.4% 0.3%; 2.4% all) groups. appears effective reducing undergo TF-CAS, without an complications. approach.TablePerioperative TF-CASaCovariatebNo protamineProtamineAdjusted odds ratio (95% CI)P valueAdjusted value(A) Sex (female)1.45 (1.2-1.9).00501.08 (0.9-1.3).4639 Race (Asian) (Ref: White)4.29 (1.4-13.1).01041.31 (0.6-3.0).5139 Symptomatic CHF1.67 (1.1-2.6).02451.21 (0.8-1.7).3206(B) (female)1.76 (1.4 – 2.2)<.0011.14 (0.8 1.7).5277ACEI, Angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; TCAR, revascularization; stenting.aOnly that statistically univariate analysis shown table.bOther covariates: age ≥65, Hispanic ethnicity, comorbidities (hypertension, diabetes, dialysis status, smoking, COPD), medications (aspirin, antiplatelet, statin, β-blockers, ACEIs/ARBs), type anesthesia. Open table new tab