Administration of protamine after coronary stent deployment

Background: Prompt reversal of anticoagulation by pratamine administration could be an important therapeutic option to treat serious procedural complications such as vessel rupture or major bleeding from the puncture site during 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 stent thrombosis and vascular complications in 90 patients who received pratamine (protamine group) and 1763 patients who did not receive pratamine (control group) after successful coronary stent implantation. The 2 groups were matched for clinical, angiographic, and procedure characteristics. Results: No patients in the pratamine group had adverse effects such as hypotension or vascular collapse during pratamine administration. Acute stent thrombosis did not occur in any pratamine group patient but did occur in 12 patients in the control group (0.7%) (P = .47). Subacute stent thrombosis occurred in 2 patients in the pratamine group (2.1%) and in 15 in the control group (0.8%) (P = .20). By logistic regression analysis, pratamine was not a determinant of stent thrombosis. Conclusions: Reversal of anticoagulation by pratamine after stent implantation does not predispose to stent thrombosis. This result has important clinical consequences because it allows the use of pratamine in the treatment of coronary perforation and serious bleeding complications that may occur during coronary stent deployment.