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Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR—A multicenter experience

Clinical Cardiology, ISSN: 1932-8737, Vol: 46, Issue: 1, Page: 67-75
2023
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Article Description

Background: Despite major advances, transcatheter aortic valve replacement (TAVR) is still associated with procedure-specific complications. Although previous studies reported lower bleeding rates in patients receiving protamine for heparin reversal, the optimal protamine-to-heparin dosing ratio is unknown. Hypothesis: The aim of this study was a comparison of two different heparin antagonization regimens for the prevention of bleeding complications after TAVR. Methods: The study included 1446 patients undergoing TAVR, of whom 623 received partial and 823 full heparin antagonization. The primary endpoint was a composite of 30-day mortality, life-threatening, and major bleeding. Safety endpoints included stroke and myocardial infarction at 30 days. Results: Full antagonization of heparin resulted in lower rates of the primary endpoint as compared to partial heparin reversal (5.6% vs. 10.4%, p <.01), which was mainly driven by lower rates of life-threatening (0.5% vs. 1.6%, p =.05) and major bleeding (3.2% vs. 7.5%, p <.01). Moreover, the incidence of major vascular complications was significantly lower in patients with full heparin reversal (3.5% vs. 7.5%, p <.01). The need for red-blood-cell transfusion was lower in patients receiving full as compared to partial heparin antagonization (10.4% vs. 15.9%, p <.01). No differences were observed in the incidence of stroke and myocardial infarction between patients with full and partial heparin reversal (2.2% vs. 2.6%, p =.73 and 0.2% vs. 0.4%, p =.64, respectively). Conclusions: Full heparin antagonization resulted in significantly lower rates of life-threatening and major bleeding after TAVR as compared to partial heparin reversal. The occurrence of stroke and myocardial infarction was low and comparable between both groups.

Bibliographic Details

Al-Kassou, Baravan; Veulemans, Verena; Shamekhi, Jasmin; Maier, Oliver; Piayda, Kerstin; Zeus, Tobias; Aksoy, Adem; Zietzer, Andreas; Meertens, Max; Mauri, Victor; Weber, Marcel; Sinning, Jan-Malte; Grube, Eberhard; Adam, Matti; Bakhtiary, Farhad; Zimmer, Sebastian; Baldus, Stephan; Kelm, Malte; Nickenig, Georg; Sedaghat, Alexander

Wiley

Medicine

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