Academic Editor: Robert C. Hendel
Background: Perioperative anticoagulation management with uninterrupted
or minimally interrupted anticoagulation during atrial fibrillation (AF) ablation
is thought to be critical to minimize thromboembolic complications. Protamine is
often administered to neutralize the effects of heparin and expedite vascular
hemostasis post-procedure. Objective: We performed a systematic review
and meta-analysis to determine the effectiveness of protamine to expedite
vascular hemostasis and ambulation in patients undergoing AF ablation.
Methods: Electronic searches on PubMed, The Cochrane Library, EMBASE,
EBSCO, Web of Science, and CINAHL databases from the inception through August 7,
2021, were performed. The primary outcomes included—time to hemostasis
(minutes) and time to ambulation (minutes). The secondary outcomes included - any
vascular complications (excluding minor hematoma), minor hematoma, or
cerebrovascular accidents (CVA). Results: A total of 5 eligible studies
(3 retrospective cohort studies and two randomized trials) consisting of 1012
patients (515 patients received protamine group and 497 patients did not receive
protamine group) were included in the meta-analysis. There was a significant
reduction in time to ambulation [weighted mean difference (WMD) –176.6 minutes,
95% Confidence interval (CI) –266.9 to –86.3; p