Comparison between complications of vascular surgery procedures with and without aPPT assessment and protamine sulfate reversal

Background: Thrombosis will occur due to contact of blood with unepithelialized surfaces after vascular clamping and also blood stasis during vascular surgery. Heparin is administered to prevent thrombosis. The aPTT test is used for assurance of the anticoagulative effect of heparin. At the end of the operation heparin is neutralized by protamine sulfate in some centers. In this study we assessed the necessity of aPTT and the use of protamine during vascular surgery. Methods: In this case-control survey 154 cases of vascular surgery were divided in to two groups, while the groups were matched regarding age, underlying disease and for vascular complications during the first postoperative 24 hours. In group A (62 cases), aPTT was determined after 2 minutes of heparin administration but heparin was not neutralized by protamine at the end of the operation. In group B (92 cases), aPTT was not determined after heparin administration but heparin was neutralized by an appropriate dose of protamine at the end of the operation. Results: Complications were seen in 4 cases of vascular surgery (2.6 %): right leg embolus in 1 case (0.65 %), spinal ischemia in 1 case (0.65 %), neuropathy in 1 case (0.6%) and hypotension due to protamine in 1 case (0.65 %). 3 cases were from group A and 1 case was from group B, but differences were not statistically significant although the power is high enough (power=70%). Conclusion: According to our findings it seems with appropriate techniques and accomplishing surgical principles, there is no need for aPTT assessment and protamine administration. This can reduce the cost and duration of operation, its complications, and prevent adverse reactions to protamine.