Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

Abstract

Background: Currently, there is no standard for the use of systemic heparin during creation of Arteriovenous (AV) fistula to decrease the incidence of postoperative thrombotic complications. Objectives: The goal of this study was to evaluate the effects of intra-operative IV heparin on patency rate and postoperative bleeding complications in patients undergoing surgery for AV fistula. Patients and Methods: A prospective, randomized controlled study was performed on 50 patients undergoing AV fistula creation, who were randomly divided in two groups. The control group received no systemic heparin and the heparin group received 5,000 units of intravenous heparin before clamping of theartery. Results: There was a significant difference in patency rate between the heparin and control groups (96% vs. 72%, P = 0.021), and there were no significant differences in operative time (P = 0.55). Perioperative bleeding was not significantly different between the two groups. Conclusions:The results suggest that intra operative administration of heparin has statistically significant effects on patency rates yet not on postoperative bleeding complications. Larger trials with longer follow-up durations and assessment of maturation rates are needed to determine this effect on fistula outcome.

Effect of Systemic Intraoperative Heparin Use on Upper Extremity Arteriovenous Fistula Patency in End-Stage Renal Disease Patients

“…A limited meta-analysis of dichotomous outcomes found a statistically significant improvement in AVF patency with heparin use ( P =0.01). Our analysis compares with a previous meta-analysis by Smith et al [ 2 ] published in 2015; however, we have the benefit of including 3 newer RCTs published since [ 1 , 6 , 7 ]. Both studies explored a primary outcome of AVF patency in the context of intraoperative heparin use.…”

“…Ebrahimifard [ 6 ] performed a single-blind randomised study comparing heparin to no anticoagulation. The case group received 5000 IU heparin prior to clamping the artery.…”

“…Heparin is only expected to last within the circulation for 1-2 hours, whereas most RCTs reported longer-term outcomes [ 2 ]. Only 2 RCTs assessed early AVF patency (24 hours post operatively) [ 6 , 7 ]. Both found a statistically significant improvement in AVF patency.…”

Does systemic heparin reduces thrombosis rate of radiocephalic fistula: A double-blinded randomized study

“…A literature review of previous studies [10][11][12][13] on the use of systemic intraoperative anticoagulants to prevent thrombosis reported variable findings. Ravari et al and Farzaneh [10,11]. have advocated towards the use of intraoperative heparin during dialysis access creation.…”