Administration of protamine after coronary stent deployment

Background Prompt reversal of anticoagulation by protamine administration c ould be an important therapeutic option to treat serious procedural complic ations such as vessel rupture or major bleeding From the puncture site duri ng coronary stent implantation. However, this therapeutic option is rarely used because of the possible risk of stent thrombosis. Methods We retrospectively analyzed the incidence of acute and subacute ste nt thrombosis and vascular complications in 90 patients who received protam ine (protamine group) and 1763 patients who did not receive protamine (cont rol group) aher successful coronary stent implantation. The 2 groups were m atched for clinical, angiographic, and procedure characteristics. Results No patients in the protamine group hod adverse effects such as hypo tension or vascular collapse during protamine administration. Acute stent t hrombosis did not occur in any protamine group patient but did occur in 12 patients in the control group (0.7%) (P = .47). Subacute stent thrombosis o ccurred in 2 patients in the protamine group (2.1%) and in 15 in the contro l group (0.8%) (P = .20). By logistic regression analysis, protamine was no t a determinant of stent thrombosis. Conclusions Reversal of anticoagulation by protamine after stent implantati on does not predispose to stent thrombosis. This result has important clini cal consequences because ii allows the use of protamine in the treatment of coronary perforation and serious bleeding complications that may occur dur ing coronary stent deployment.