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经皮冠状动脉介入治疗术后鱼精蛋白对肝素抗凝作用的逆转：一项系统综述和荟萃分析
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Abstract:
Objective: To systematically evaluate the safety and efficacy of protamine in reversing heparin anticoagulation after percutaneous coronary intervention (PCI). Methods: Systematic searches were conducted in PubMed and the Cochrane Library databases to identify relevant literature on protamine reversing heparin anticoagulation after PCI. The search period was set from the database establishment to 2023, and the references of included literature were also traced. The researchers screened the literature according to the inclusion and exclusion criteria and extracted the valid data for quality evaluation. Meta-analysis was performed using Stata 16.0 software. Results: A total of 9 articles were included in this study. The Meta-analysis results showed that using protamine after PCI significantly reduced the incidence of hematoma [RR = 0.49, 95% CI: 0.37~0.66] and the risk of in-stent thrombosis [RR = 0.34, 95% CI: 0.14~0.83] in patients, but had no significant effect on the total mortality [RR = 0.98, 95% CI: 0.59~1.63], myocardial infarction, and the incidence of hypotension [RR = 0.98, 95% CI: 0.86~1.13]. Conclusion: This study confirmed that using protamine to reverse heparin anticoagulation after PCI can reduce the incidence of hematoma and in-stent thrombosis in patients after PCI, and does not increase the mortality, myocardial infarction, and the incidence of hypotension in patients, demonstrating certain safety and efficacy.
| [1] | Jiang, Y., Liu, Y., Jia, X., Xin, W. and Wang, H. (2022) The Emerging Role of Adopting Protamine for Reducing the Risk of Bleeding Complications during the Percutaneous Coronary Intervention: A Meta‐Analysis. Journal of Cardiac Surgery, 37, 5341-5350. https://doi.org/10.1111/jocs.17139 |
| [2] | 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6): 521-545. |
| [3] | Danek, B.A., Kearney, K.E., Chung, C.J., Steinberg, Z., Lombardi, W.L., McCabe, J.M., et al. (2023) The Contemporary Role of Protamine in the Cardiac Catheterization Laboratory. Catheterization and Cardiovascular Interventions, 102, 111-120. https://doi.org/10.1002/ccd.30679 |
| [4] | Alkhalil, M. (2022) An Overview of Current Advances in Contemporary Percutaneous Coronary Intervention. Current Cardiology Reviews, 18, Article ID: e150322202194. https://doi.org/10.2174/1573403x1801220315090538 |
| [5] | Lee, P.Y., Bello, J., Ye, C., Varadarajan, S., Hossain, A., Jumkhawala, S., et al. (2023) Safety of Routine Protamine in the Reversal of Heparin in Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. International Journal of Cardiology, 388, Article 131168. https://doi.org/10.1016/j.ijcard.2023.131168 |
| [6] | Kubota, M., Sakakura, K., Yamamoto, K., Taniguchi, Y., Tsukui, T., Seguchi, M., et al. (2020) Mid-Term Clinical Outcomes of Immediate Protamine Use Following Elective Percutaneous Coronary Interventions. International Heart Journal, 61, 865-871. https://doi.org/10.1536/ihj.20-126 |
| [7] | Schallom, M.E., Prentice, D., Sona, C., Micek, S.T. and Skrupky, L.P. (2012) Heparin or 0.9% Sodium Chloride to Maintain Central Venous Catheter Patency. Critical Care Medicine, 40, 1820-1826. https://doi.org/10.1097/ccm.0b013e31824e11b4 |
| [8] | Chavez‐Ponce, A., El Shaer, A., Samimi, S., Sulaiman, S., Harris, A. and Alkhouli, M. (2023) Utilization and Outcomes of Protamine after Percutaneous Left Atrial Appendage Occlusion. Catheterization and Cardiovascular Interventions, 102, 293-300. https://doi.org/10.1002/ccd.30743 |
| [9] | Boer, C., Meesters, M.I., Veerhoek, D. and Vonk, A.B.A. (2018) Anticoagulant and Side-Effects of Protamine in Cardiac Surgery: A Narrative Review. British Journal of Anaesthesia, 120, 914-927. https://doi.org/10.1016/j.bja.2018.01.023 |
| [10] | Zbroński, K., Grodecki, K., Gozdowska, R., Ostrowska, E., Wysińska, J., Rymuza, B., et al. (2021) Protamine Sulfate during Transcatheter Aortic Valve Implantation (PS TAVI)—A Single-Center, Single-Blind, Randomized Placebo-Controlled Trial. Kardiologia Polska, 79, 995-1002. https://doi.org/10.33963/kp.a2021.0070 |
| [11] | Choi, J.H., Chun, K.J., Jung, S.M., Lee, S.Y., Chon, M.K., Lee, S.H., et al. (2022) Safety and Efficacy of Immediate Heparin Reversal with Protamine after Complex Percutaneous Coronary Intervention. BMC Cardiovascular Disorders, 22, Article No. 207. https://doi.org/10.1186/s12872-022-02650-5 |
| [12] | Liang, P., Motaganahalli, R., Swerdlow, N.J., Dansey, K., Varkevisser, R.R.B., Li, C., et al. (2021) Protamine Use in Transfemoral Carotid Artery Stenting Is Not Associated with an Increased Risk of Thromboembolic Events. Journal of Vascular Surgery, 73, 142-150.E4. https://doi.org/10.1016/j.jvs.2020.04.526 |
| [13] | Rossi, M.L., Zavalloni, D., Scatturin, M., Gasparini, G.L., Lisignoli, V. and Presbitero, P. (2007) Immediate Removal of Femoral-Sheath Following Protamine Administration in Patients Undergoing Intracoronary Paclitaxel-Eluting-Stent Implantation. Expert Opinion on Pharmacotherapy, 8, 2017-2024. https://doi.org/10.1517/14656566.8.13.2017 |
| [14] | Parodi, G., Migliorini, A., Valenti, R., Bellandi, B., Signorini, U., Moschi, G., et al. (2010) Comparison of Bivalirudin and Unfractionated Heparin Plus Protamine in Patients with Coronary Heart Disease Undergoing Percutaneous Coronary Intervention (from the Antithrombotic Regimens and Outcome [ARNO] Trial). The American Journal of Cardiology, 105, 1053-1059. https://doi.org/10.1016/j.amjcard.2009.12.001 |
| [15] | Hanna, N., Fiorilli, P., Gaglia, Jr., M.A., Torguson, R., Vita, A., Ben-Dor, I., et al. (2011) Low‐Dose Protamine to Facilitate Earlier Sheath Removal from the Femoral Artery after Peripheral Endovascular Intervention. Journal of Interventional Cardiology, 24, 278-284. https://doi.org/10.1111/j.1540-8183.2011.00642.x |
| [16] | Briguori, C., Di Mario, C., De Gregorio, J., Sheiban, I., Vaghetti, M. and Colombo, A. (1999) Administration of Protamine after Coronary Stent Deployment. American Heart Journal, 138, 64-68. https://doi.org/10.1016/s0002-8703(99)70248-6 |
| [17] | Thuesen, L., Andersen, H.R., Bøtker, H.E., et al. (2005) In-Laboratory Femoral Sheath Removal after Heparin Reversal by Protamine after Percutaneous Coronary Intervention. EuroIntervention, 1, 66-69. |
| [18] | Lohne, F., Kløw, N.E., Stavnes, S., Brekke, M., Hoffmann, P., Stensæth, K.H., et al. (2004) Safety of Heparin Reversal with Protamin and Immediate Sheath Removal after Coronary Angioplasty. Acta Radiologica, 45, 171-175. https://doi.org/10.1080/02841850410003743 |
| [19] | Moran, K.E., Ommerborn, M.J., Blackshear, C.T., Sims, M. and Clark, C.R. (2019) Financial Stress and Risk of Coronary Heart Disease in the Jackson Heart Study. American Journal of Preventive Medicine, 56, 224-231. https://doi.org/10.1016/j.amepre.2018.09.022 |
| [20] | Zbroński, K., Grodecki, K., Gozdowska, R., Jędrzejczyk, S., Ostrowska, E., Wysińska, J., et al. (2020) Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. Advances in Interventional Cardiology, 16, 306-314. https://doi.org/10.5114/aic.2020.99266 |
| [21] | GBD 2017 Causes of Death Collaborators (2018) Global, Regional, and National Age-Sex-Specific Mortality for 282 Causes of Death in 195 Countries and Territories, 1980-2017: A Systematic Analysis for the Global Burden of Disease Study 2017. The Lancet, 392, 1736-1788. |
| [22] | Maneno, J.N. and Ness, G.L. (2020) Andexanet Alfa, the Possible Alternative to Protamine for Reversal of Unfractionated Heparin. Annals of Pharmacotherapy, 55, 261-264. https://doi.org/10.1177/1060028020943160 |
| [23] | Kaluski, E., Krakover, R., Cotter, G., Hendler, A., Zyssman, I., Milovanov, O., et al. (2000) Minimal Heparinization in Coronary Angioplasty—How Much Heparin Is Really Warranted? The American Journal of Cardiology, 85, 953-956. https://doi.org/10.1016/s0002-9149(99)00908-x |
| [24] | Danek, B.A., Kearney, K.E., Chung, C.J., Steinberg, Z., Lombardi, W.L., McCabe, J.M., et al. (2023) The Contemporary Role of Protamine in the Cardiac Catheterization Laboratory. Catheterization and Cardiovascular Interventions, 102, 111-120. https://doi.org/10.1002/ccd.30679 |
| [25] | Pai, M. and Crowther, M.A. (2011) Neutralization of Heparin Activity. In: Lever, R., Mulloy, B. and Page, C., Eds., Handbook of Experimental Pharmacology, Springer, 265-277. https://doi.org/10.1007/978-3-642-23056-1_11 |
