The influence of neutralizing or not neutralizing
heparin after
carotid endarterectomy on postoperative
stroke and
wound hematoma is unknown. During the past 6 years some of the authors frequently gave
protamine sulfate to neutralize
heparin, whereas others did not unless a patch was used or
wound hemostasis was not readily obtained. To determine the influence of
protamine sulfate on
stroke and
wound hematoma the records of 697 patients having a
carotid endarterectomy from January 1984 to September 1989 were reviewed.
Protamine sulfate was given to 328 patients, and 369 did not receive
protamine sulfate. The incidence of
stroke in the two groups was 1.8% (n = 6) and 2.7% (n = 10), respectively, and the difference was not significant (p = 0.6019). Excluding three
strokes that could not be related to neutralizing or not neutralizing
heparin, the difference remained insignificant (1.5% vs 2.2%, p = 0.7290). The incidence of
wound hematoma was 1.8% (n = 6) in patients given
protamine sulfate and 6.5% (n = 24) in patients not given
protamine sulfate, and this difference was significant (p = 0.0044). The difference remained significant when three
hematomas not related to
protamine sulfate were excluded (1.2% vs 6.2%, p = 0.0013). In patients not given
protamine sulfate draining the
wound lessened the incidence of
wound hematoma (4.4% vs 8.6%), but this difference was not statistically significant (p = 0.1475). In patients given
protamine sulfate the dose of
protamine sulfate (15 to 45 mg vs 50 to 75 mg) had no statistically significant effect on the incidence of
stroke (0.8% vs 2.0%, p = 0.6530) or
wound hematoma (1.6% vs 1.0%, p = 1.000).