“During the past decade, technical and clinical advances have been achieved in the field of interventional aortic valve therapy, overcoming some of the initial procedure-related drawbacks,” wrote first author Baravan Al-Kassou, MD, University Hospital Bonn in Germany, and colleagues. “Increasing experience has allowed the implementation of clinical best practice recommendations, and the introduction of next-generation transcatheter heart valves has significantly improved patient outcomes by facilitating the procedure and thus decreasing procedure-related complications. Despite all of these achievements, TAVR is still associated with several procedure-specific complications that can have a significant impact on short- and long-term morbidity and mortality. Among these, vascular and bleeding complications are the most frequent procedure-related complications.”
Researchers tracked how heparin reversal through the administration of protamine impacted 677 patients who underwent TAVR, comparing the outcomes with another 196 TAVR patients who did not receive protamine. All patients were treated at the same facility from February 2013 to May 2018.
Overall, the study’s primary endpoint—a composite of 30-day all-cause mortality, life-threatening bleeding and major bleeding—occurred 3.2% of the time in the protamine group and 8.7% of the time in the control group. Life-threatening bleeding events dropped 96% with protamine administration and major bleeding events dropped 75%.
In addition, the protamine group experienced “significantly shorter” hospital stays and the need for red blood cell transfusion was down 38%. And stroke and myocardial infarction occurred at similar rates for the two groups, confirming that protamine administration was a safe treatment option.