Uso de protamina para retirada precoce dos introdutores femorais após angioplastia coronária com implante de Stent

• Autor(a) principal: Gonçalves, Bernardo Kremer Diniz
• Data de Publicação: 2011
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal Fluminense (RIUFF)
• Texto Completo: https://app.uff.br/riuff/handle/1/19448
• topic: Angioplastia; Stent; Trombose de stent; Protamina; Heparina; Introdutores femorais.; CARDIOLOGIA; MEDICINA; Angioplasty; Stent; Stent thrombosis; Heparin; Protamine; Femoral sheath.; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIA

Coronary angioplasty with stent implantation is a therapeutic method widely used in interventional cardiology for the treatment of coronary lesions. This technique often runs through puncture with the placement of a hemostatic introducer in the femoral artery. These sheaths must be removed after the procedure as soon as there is a normalization of blood crase, which can take several hours. This time can be shortened with the use of protamine, but its use is not widespread because of the potential increased risk of acute or subacute stent thrombosis. The objective of this study was to demonstrate the safety of the use of Protamine for the reversal of heparin anticoagulant effects after coronary angioplasty with stent implant, through absence of correlation of the drug use with the occurrence of acute or subacute stent thrombosis. 6,318 patients undergoing coronary angioplasty were evaluated in the Procordis hospital in the time span from June 1998 to January 2011. 5,290 patients fulfilled the criteria for inclusion and were divided into two groups: those who had received protamine after the intervention, consisting of 3,965 patients, and those who did not receive this drug, consisting of 1,325 patients. Univariate analysis was made to evaluate clinical parameters, angiographic data and the presence of stent thrombosis. The group that received no Protamine presented a greater percentage of diabetic patients (38.1% versus 27.4% p <0.0001), patients with cardiogenic shock (7.17% versus 1.11% p <0.0001), the presence of myocardial infarction with ST segment unbalance (22.5% versus 10.8% p <0.0001). However, the angiographic profile in the group that received Protamine featured greater occurrence of eccentric lesions (98.1% versus 94.1% p < 0.0001), more type C lesions (53.2% versus 40.5% p <0.0001), vessels with diameters smaller than 2.5 mm (23.2% versus 15.6% p< 0.0001), whereas the group without the protamine featured more injuries with presence of angiographic thrombi (25.3% versus 13.6% p<0.0001). Afterwards, there was a second division: subjects showing stent thrombosis, consisting of 26 patients, and those who did not have this complication, consisting of 5,270 patients. Univariate analysis for clinical and angiographic parameters and multivariate calculus, in order to identify independent predictors for stent thrombosis were performed and identified only acute infarction with ST segment unbalance as independent predictors. We found that the use of Protamine is safe after coronary intervention with stent implantation, as it was not associated with increased occurrence of acute and subacute thrombosis.