741-4 Preliminary Experience Using Protamine to Reverse Heparin Immediately Following a Successful Coronary Stent Implantation

Abstract

Previous reports have documented the safety of the treatment only with antiplatelet therapy and no subsequent anticoagulation following stent implantation with optimal stent expansion confirmed by intravascular ultrasound (IVUS). More recently, protamine has been used in selected patients after a successful stent implantation procedure to decrease hematoma formation, and to facilitate early sheath removal and hospital discharge. Lesions were selected on the basis of an optimal angiographic and IVUS result and unimpaired distal runoff. The cohort includes 30 consecutive patients (pts) with 37 lesions (les) that received protamine following a successful stent implantation. All pts were subsequently treated only with antiplatelet therapy and no subsequent anticoagulation. The mean age was 58 ± 11. Indication for stent implantation was elective in 32 les (90%) and emergency for threatened closure in 5 lesions (10%). Vessel distribution was 15 LAD (41%), 15 RCA(41%), 6 LCX (16%), and 1 Left Main (3%). Lesion location was 22 proximal (59%), 11 mid/distal (41%),51 stents (39 Palmaz-Schatz, 9 Gianturco-Roubin, and 3 Wiktor) were used for an average of 1.4 ± 0.7 stentsllesion. The protamine dose was 41 ± 20 (range 12.5 mg to 50 mg). ACT priorto protamine was 300 ± 69 (range 185 to 481). Angiographic (AG) and IVUS results are below: Proximal Reference Lesion or Stent Stenosis (%) Distal Reference Baseline AG (mm) 3.10 ± 0.50 0.92 ± 0.0.53 (72 ± 16) 2.98 ± 0.48 Post Stent AG (mm) 3.19 ± 0.42 3.04 ± 0.48 (-2 ± 13) 3.06 ± 048 IVUS Lumen (mm 2 ) 9.3 ± 3.0 7.6 ± 1.6 7.1 ± 2.4 There were no acute or subacute stent thrombosis events at 1 month clinical follow up. Vascular complications included 1 pseudoaneuysm treated with external compression and 3 minor hemotomas. Mean hospital stay was 2 ± 2 days. (1) Protamine given immediately following a successful stent implantation with optimal stent expansion confirmed by IVUS did not cause stent thrombosis. (2) The results of this small cohort would support the feasability of using protamine to facilitate sheath removal and hospital discharge in selected patients after stent implantation assisted by IVUS.