Safety and efficacy of protamine after transcatheter aortic valve replacement

Indian Heart J. 2024 Sep-Oct;76(5):352-354. doi: 10.1016/j.ihj.2024.09.001. Epub 2024 Sep 24.

Abstract

Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe alternative to surgical aortic valve replacement (SAVR). Protamine is used to reverse heparin and reduce post-TAVR bleeding, but concerns about risks like valve thrombosis and stroke remain. This systematic review and meta-analysis, following PRISMA guidelines, found no statistically significant difference in major bleeding complications between the protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No differences were noted in life-threatening bleeding, blood transfusions, 30-day mortality, or stroke. Protamine appears safe post-TAVR without increasing stroke risk, but its effectiveness in reducing bleeding needs further investigation through a multicentric randomized study.

Keywords: Protamine; Transfemoral Trans-catheter aortic valve replacement; Vascular complications.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / surgery
  • Heparin Antagonists* / therapeutic use
  • Humans
  • Postoperative Hemorrhage / epidemiology
  • Protamines* / therapeutic use
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / methods
  • Treatment Outcome

Substances

  • Protamines
  • Heparin Antagonists