{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T17:05:12Z","timestamp":1763571912013,"version":"3.45.0"},"reference-count":17,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiology"],"abstract":"<jats:p>Introduction: Transcatheter aortic valve implantation (TAVI) may be complicated by postoperative bleeding due to heparin use. Heparin antagonists, such as protamine, have shown potential in reducing bleeding risks. This meta-analysis assesses the efficacy and safety of protamine in reducing bleeding complications after TAVI. Methods: A systematic search was conducted up to March 2025. Inclusion criteria encompassed studies reporting the use of protamine post-TAVI with a control group. Primary outcomes included major bleeding events as the efficacy endpoint, 30-day mortality, and ischemic events (stroke and transient ischemic attack, or TIA) as safety endpoints. Secondary outcomes included life-threatening bleeding events and the need for blood transfusion. A random-effects model was used to calculate odds ratios (ORs). Results: Four studies involving 1,569 patients were included. As compared to the control group, protamine was not associated with a statistically significant difference in major bleeding events (OR = 0.59, 95% CI = 0.26\u20131.34, p = 0.21), life-threatening bleeding events (OR = 0.3, 95% CI = 0.06\u20131.62, p = 0.16), need for blood transfusions (OR = 0.75, 95% CI = 0.46\u20131.24, p = 0.27), 30-day mortality (OR = 1.07, 95% CI = 0.54\u20132.11, p = 0.85), or rate of stroke and TIA (OR = 0.86, 95% CI = 0.05\u201313.58, p = 0.91). Conclusion: Protamine use after TAVI appeared to be safe with no increase in 30-day mortality or stroke and TIA rates, but there was no observed statistically significant benefit in the reduction of major or life-threatening bleeding events and the need for blood transfusions. These findings are based on a limited number of studies, and larger randomized controlled trials are warranted to confirm them.<\/jats:p>","DOI":"10.1159\/000549115","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T16:00:58Z","timestamp":1761235258000},"page":"1-9","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Protamine Use following Transcatheter Aortic Valve Implantation for Minimizing Post-Procedural Bleeding Risk: A Systematic Review and Meta-Analysis"],"prefix":"10.1159","author":[{"given":"Arwi Omar","family":"Kara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0113-5117","authenticated-orcid":false,"given":"Mohammed S.","family":"Beshr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1940-4258","authenticated-orcid":false,"given":"Ali 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