Abstract 10572: Efficacy and Safety of Protamine After Catheter Ablation of Atrial Fibrillation: Systematic Review and Meta-Analysis

Abstract

Introduction: Perioperative anticoagulation management with uninterrupted or minimally interrupted anticoagulation during atrial fibrillation (AF) ablation is thought to be critical to minimize thromboembolic complications. Protamine is often administered to neutralize the effects of heparin and expedite vascular hemostasis post-procedure. Hypothesis: To determine the efficacy and safety of protamine to expedite vascular hemostasis and ambulation in patients undergoing AF ablation. Methods: Electronic searches on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from the inception through June 7, 2021, were performed. The primary outcome was time to ambulate (minutes) and hemostasis (minutes). The secondary outcome was any vascular complications or minor hematoma or cerebrovascular accidents. Results: A total of 5 eligible studies consisting of 637 patients (Protamine group: 515 and no protamine group: 497) were included in the meta-analysis. There was a significant reduction in time to ambulation {mean difference (MD): -176.60, 95% CI -266.87 - -86.32; p< 0.01} and in time to hemostasis between the two groups (MD -13.72, 95% CI -22.01 - -5.44, p<0.01) in the protamine group. There were no differences in the rates of vascular complications (RR 0.46 95% CI 0.17-1.24 for any vascular complication; RR 0.43, 95% CI 0.16-1.2 for minor hematoma) or cerebrovascular accidents (RR 0.62, 95% CI 0.08 - 4.98) between the two groups. Conclusions: Protamine administration was associated with reduced time to ambulation (176 minutes reduction) and time to hemostasis (13 minutes reduction) without an increase in any adverse events.