Abstract 12642: Protamine Administration in Patients Undergoing Percutaneous Left Atrial Appendage Occlusion

Introduction: Intravenous protamine sulfate is widely used to reverse anticoagulation after structural heart interventions. Protamine is currently designated as in shortage by the US FDA, and its use has potential adverse events such as anaphylaxis, thrombosis, and stroke. There is limited data on the safety and efficacy of heparin reversal with protamine after left atrial appendage occlusion (LAAO). Hypothesis: We hypothesize that patients who received protamine for heparin reversal after percutaneous LAAO have no changes in bleeding complication rates versus patients who did not receive protamine. Methods: This retrospective study included 242 atrial fibrillation patients with a high risk of stroke and bleeding who received percutaneous LAAO between January 2020 and November 2021. The primary outcome assessed was life-threatening, disabling, or major bleeding within 48 hours following the procedure. Secondary outcomes included major adverse cardiac events (MACE) within 48 hours, minor bleeding events, MACE, device-related thrombosis or pericardial effusion within 45 days, and RBC transfusions. Patients with peri-procedure complications including pericardial effusion and/or thrombosis were excluded. Baseline characteristics were compared between both cohorts. Results: No significant difference in the primary outcome was observed between patients who received protamine compared to those who did not (5.8% vs 4.9%, p-value 0.57). There was significantly more minor bleeding in patients who did not receive protamine (0.6% vs 4.9%, p-value 0.05). MACE within 48h following the procedure, MACE, device-related thrombosis or pericardial effusion within 45 days, and RBC transfusions were comparable between the two cohorts, as described in table 2. Conclusions: Protamine administration for heparin reversal did not affect rates of life-threatening, disabling, or major bleeding complications in patients who underwent percutaneous LAAO.