Alrayes Hussayn, Alsaadi Ayman, Alkhatib Ahmad, Patel Dhruvil Ashishkumar, Alqarqaz Mohammad, Frisoli Tiberio, Fuller Brittany, Khandelwal Akshay, Koenig Gerald, O'Neill Brian P, Villablanca Pedro, Zaidan Mohammad, O'Neill William, Alaswad Khaldoon, Basir Mir
Department of Cardiovascular Medicine, Henry Ford Health Systems, Detroit, Michigan. Email:
Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan.
J Invasive Cardiol. 2025 Jun;37(6). doi: 10.25270/jic/24.00336.
There is a paucity of data on the use of protamine after PCI. The purpose of this study was to assess the incidence of thrombotic complications of protamine after high-risk PCI.
The authors conducted a retrospective analysis of 168 patients. All patients received protamine intra- or immediately post-index PCI. Baseline characteristics and procedural characteristics including heparin dosing, protamine dosing, and bleeding and thrombotic complications were evaluated. The primary outcome was the incidence of acute stent thrombosis (ST), subacute ST, and 'other' thrombotic complications. Secondary outcomes included mortality within 24 hours and within 30 days of the index procedure.
A total of 168 patients were included. The majority of patients received dual anti-platelet therapy prior to the index procedure (85%). The average procedure time was 202 ± 103 minutes, and an average of 2.59 (± 1.38) stents were deployed. An average protamine dose of 32mg was administered, and the median dose was 20mg (IQR 20). Seventy-three (43%) had a coronary perforation and five (3%) had access site related bleeding requiring transfusion. Four (2%) patients had acute ST, no patients experienced subacute ST, and 2 (1%) patients developed non-coronary arterial thrombosis. Eight (5%) died within 24 hours of their PCI and 14 (8%) patients died within 30 days after PCI.
In our cohort, administration of protamine was well tolerated in the majority of patients, however, 3.6% of patients did experience coronary or peripheral arterial thrombosis warranting caution when using protamine in these challenging scenarios.
关于经皮冠状动脉介入治疗（PCI）后使用鱼精蛋白的数据较少。本研究的目的是评估高危PCI后鱼精蛋白血栓形成并发症的发生率。
作者对168例患者进行了回顾性分析。所有患者在首次PCI术中或术后立即接受了鱼精蛋白治疗。评估了基线特征和手术特征，包括肝素剂量、鱼精蛋白剂量以及出血和血栓形成并发症。主要结局是急性支架血栓形成（ST）、亚急性ST和“其他”血栓形成并发症的发生率。次要结局包括首次手术后24小时内和30天内的死亡率。
共纳入168例患者。大多数患者在首次手术前接受了双联抗血小板治疗（85%）。平均手术时间为202±103分钟，平均植入2.59（±1.38）枚支架。平均给予鱼精蛋白剂量为32mg，中位剂量为20mg（四分位间距20）。73例（43%）发生冠状动脉穿孔，5例（3%）发生需要输血的穿刺部位相关出血。4例（2%）患者发生急性ST，无患者发生亚急性ST，2例（1%）患者发生非冠状动脉血栓形成。8例（5%）患者在PCI术后24小时内死亡，14例（8%）患者在PCI术后30天内死亡。
在我们的队列中，大多数患者对鱼精蛋白的耐受性良好，然而，3.6%的患者确实发生了冠状动脉或外周动脉血栓形成，在这些具有挑战性的情况下使用鱼精蛋白时应谨慎。
