Aaron Tansy, MD

  • McDonald JS
  • Kallmes DF
  • Lanzino G
  • and Cloft HJ. 
  • Protamine Does Not Increase Risk of Stroke in Patients With Elective Carotid Stenting. Stroke. 2013

    Still in its relative infancy, the neuroendovascular field has adopted many of its procedural methods from those within interventional cardiology and vascular surgery on the assumption that they have already been tested and deemed safe within these preceding domains. As a result, whether the safety and efficacy of many of these practices actually generalizes to the neuroendovascular field is still unproven. 

    In a paper published in Stroke, Jennifer McDonald and colleagues address the safety and efficacy of protamine to promote hemostasis and reduce femoral access site bleeding after elective carotid angioplasty and stenting. The group performed a retrospective analysis of patient data culled from a national, multi-center database comparing outcomes for carotid stenting patients who received protamine matched against those who did not. For both primary (ischemic stroke or TIA) and multiple secondary outcomes including mortality, ICH, and peripheral vascular complications, post-procedure protamine administration was not associated with significantly worse outcomes. Only blood transfusion incidence was significantly higher for those who received protamine compared to those who did not.

    Limited by its methodology including selection bias, urban-based hospital focus, unknown context for and non-standardized administration of protamine, this study does not provides any definite or readily generalizable conclusions. However, it does suggest that protamine’s use imparts no more danger than not using it after carotid stenting: in of itself, hardly a compelling reason for its use. Still, this finding provides a little fodder to evaluate further whether protamine’s post-procedural use may not only be no less safe, but also possibly safer.