A Comparison between Complications of Vascular Surgery Procedures with and without aPPT Assessment and Protamin Sulfate Reverse

Thrombosis occurs when blood comes into contact with unepithelialized surfaces after vascular clamp and also blood stasis during vascular surgeries. Heparin is administered to prevent thrombosis, and aPTT (activatedPartial Thromboplastin Time) test is used to make sure of anticoagulative effect of heparin. At the end of the operation, heparin is neutralized by protamin sulfate in some centers. In this study we assessed the necessity of aPTT and using protamin during vascular surgeries.Patients and In this case-control survey, 154 cases of vascular surgery were divided into two groups which were matched regarding age and underlying diseases. The subjects were monitored for vascular complications during the first postoperative 24 hours. In group A (62 cases), aPTT was determined after 2 minutes of heparin administration but heparin was not neutralized by protamin at the end of the operation. In group B (92 cases), aPTT was not determined after heparin administration but heparin was neutralized by an appropriate dose of protamin at the end of the operation. To obtain mean and frequency the data were analyzed descriptively and analytical techniques such as Chi-square and t-test were implemented using SPSS 14. Vascular surgery complications were seen in 4 cases (26%): right leg embolus in 1 case (0.65%), spinal ischemia in 1 case (0.65%), left leg neuropathy in 1 case (0.65%), and hypotension due to protamin in 1 case (0.65%). 3 cases were from group A and 1 case was from group B. Nevertheless, the observed difference was not statistically significant although the power was high enough (power=70%). According to our findings, it seems by applying appropriate techniques and accomplishing surgical principles, there is no need for aPTT assessment and protamin administration. This can reduce the cost, duration and complications of operation and prevent adverse effects of protamin.