The use of low-dose heparin is safe in carotid endarterectomy and avoids the use of protamine sulfate

Controversy exists concerning the appropriate dose of heparin needed during carotid endarterectomy, Use of high-dose heparin (100 U/kg) during carotid endarterectomy may require the use of protamine to minimize perioperative bleeding complications, At the authors' institution the use of 30 U/kg hepa rin for arterial reconstruction has obviated the need for protamine. A retr ospective study of carotid endarterectomies performed was undertaken. Patie nts undergoing combined procedures with carotid endarterectomy were exclude d. A total of 420 carotid endarterectomies were performed in 330 patients. All received 3000 U of heparin or less during carotid endarterectomy. Non-f atal stroke and transient neurological deficits occurred in 0.48% and 1.9%, respectively. Mortality was 0.9%. Wounds were dry in 97%, swollen in 2.5% and bloody in 0.5%. No patient received protamine. Two patients were return ed to the operating room for re-exploration because of hematoma, In conclus ion, the use of protamine may be safely avoided with 30 U/kg heparin, and g ive acceptable stroke- and minimal complication rates. (C) 1998 The Interna tional Society for Cardiovascular Surgery. Published by Elsevier Science Lt d. All rights reserved.