A new meta-analysis of over 87,000 patients suggests that giving protamine during carotid endarterectomy (CEA) may reduce the risk of bleeding complications. The study, which pooled data from multiple sources, found that protamine use was linked to about half the odds of developing any cervical haematoma (OR 0.49) and haematomas requiring re-operation (OR 0.48). Additionally, the odds of stroke were about 15% lower (OR 0.85). However, no significant difference in mortality was observed.
The findings are promising, but the certainty of the evidence is very low according to GRADE criteria. This means the true effects could be substantially different from these estimates. The analysis included a mix of study designs, and the quality of the underlying data was limited.
For patients undergoing CEA, these results suggest that protamine might help prevent bleeding without increasing harm. However, doctors should weigh the potential benefits against the low-quality evidence. More rigorous studies are needed to confirm these findings and establish optimal dosing.
Overall, protamine appears to be a safe and potentially effective option to reduce haematoma and stroke risk during CEA, but the evidence is not strong enough to change practice definitively.
