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Primary thromboprophylaxis with heparins for arteriovenous fistula failure in pediatric patients

A Sharathkumar1, R Hirschl, S Pipe

  • 1Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA. aalatkar@umich.edu

The Journal of Vascular Access
|December 29, 2007
PubMed

Insights

Primary thromboprophylaxis (PTP) significantly reduced arteriovenous fistula thrombosis in pediatric hemodialysis patients. This protocol, using low molecular weight heparin, proved feasible for preventing early AVF failure.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Pediatric Medicine

Background:

  • Early arteriovenous fistula (AVF) failure, primarily due to thrombosis, is a significant challenge in pediatric hemodialysis (HD).
  • A primary thromboprophylaxis (PTP) protocol was implemented to mitigate this issue.

Purpose of the Study:

  • To evaluate the effectiveness and feasibility of a PTP protocol in preventing early AVF thrombosis in pediatric HD patients.
  • To report institutional experience with the PTP protocol one year after its initiation.

Main Methods:

  • The study compared AVFs created before (Historical group) and after (PTP group) the PTP protocol implementation.
  • PTP involved postoperative unfractionated heparin followed by subcutaneous low molecular weight heparin (LMWH) with adjusted dosing based on thrombosis risk.
  • Historical group AVFs were categorized into no treatment, aspirin, or LMWH subgroups.

Main Results:

  • The PTP group experienced a significantly lower incidence of thrombosis (12.5%) compared to the no-treatment historical group (83%) (p < 0.05).
  • One AVF in the PTP group failed due to stenosis; early complications included hematoma requiring LMWH dose adjustment.
  • The aspirin group had one thrombosis failure, while the no-treatment group had nine thromboses and one stenosis.

Conclusions:

  • Primary thromboprophylaxis (PTP) is a viable strategy for preventing early AVF thrombosis in pediatric hemodialysis.
  • Close clinical and laboratory monitoring, including trough anti-factor Xa levels, is crucial for optimizing anticoagulation.
  • Further research is necessary to establish the safety and efficacy of this PTP protocol in larger cohorts.
Abstract

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