Abstract | BACKGROUND: To reduce the incidence of early arteriovenous fistula failure (AVF) due to thrombosis in pediatric hemodialysis (HD) patients, a primary thromboprophylaxis ( PTP) protocol was initiated at author's institution in June 2005. The goal of this study is to report author's experience with this protocol one year later. METHODS AND RESULTS: 19 AVFs (14 patients, Historical group) and 8 AVFs (7 patients, PTP group) were created prior to and after initiation of PTP respectively. PTP consisted of unfractionated heparin (5-10 units/kg/hr) infusion postoperatively, followed by subcutaneous low molecular weigh heparin ( LMWH) until AVF was matured. LMWH dosing was 'Prophylactic' (0.5 mg/kg/d, anti- factor Xa levels: peak 0.25-0.5 and trough < 0.3 units/mL) and 'Therapeutic' (1 mg/kg/d, anti- factor Xa level: peak 0.5-1 and trough < 0.5 units/mL) based on thrombosis predisposition. In Historical group, 12 AVFs did not receive thromboprophylaxis (No-treatment group), 5 received 81 mg aspirin/day ( Aspirin group), and 2 received LMWH. In No-treatment group 10/12 AVFs failed: 9 thromboses and 1 stenosis. In Aspirin group 1/5 AVFs failed due to thrombosis. In PTP group 1/8 AVFs failed due to stenosis; the first 2 AVFs developed hematoma prompting a reduction in LMWH dose and monitoring trough anti- factor Xa levels, one AVF required thrombectomy after LMWH was transiently held. The incidence of thrombosis was less in PTP group (12.5%) when comparing to No-treatment group (83%) (p < 0.05). CONCLUSION: PTP is a feasible option to prevent early thrombosis at AVF. Close clinical and laboratory monitoring including trough anti- factor Xa levels is required to adjust optimum anticoagulation. Larger studies are needed to clarify safety and efficacy of our PTP protocol.
|
Authors | A Sharathkumar, R Hirschl, S Pipe, C Crandell, B Adams, J J Lin |
Journal | The journal of vascular access
(J Vasc Access)
2007 Oct-Dec
Vol. 8
Issue 4
Pg. 235-44
ISSN: 1129-7298 [Print] United States |
PMID | 18161668
(Publication Type: Controlled Clinical Trial, Journal Article)
|
Chemical References |
- Fibrinolytic Agents
- Heparin, Low-Molecular-Weight
- Heparin
- Aspirin
|
Topics |
- Adolescent
- Adult
- Arteriovenous Shunt, Surgical
(adverse effects)
- Aspirin
(therapeutic use)
- Child
- Clinical Protocols
- Drug Administration Schedule
- Drug Monitoring
- Feasibility Studies
- Fibrinolytic Agents
(administration & dosage, adverse effects, therapeutic use)
- Heparin
(administration & dosage, adverse effects, therapeutic use)
- Heparin, Low-Molecular-Weight
(therapeutic use)
- Humans
- Infusions, Intravenous
- Injections, Intravenous
- Injections, Subcutaneous
- Program Evaluation
- Renal Dialysis
- Thrombosis
(etiology, physiopathology, prevention & control)
- Time Factors
- Treatment Failure
- Vascular Patency
(drug effects)
|