Role of systemic anticoagulation in patients undergoing vascular access surgery

The role of per-operative systemic heparin to improve primary patency rate of vascular access surgery is controversial. The aim of this study was to assess the risk and benefit of systemic heparin during creation of vascular access for hemodialysis in patients with chronic renal failure. Patients undergoing creation of side to end radio-cephalic arteriovenous fistula over distal forearm for hemodialysis were prospectively randomized into two groups. First group received 5000 IU of intravenous heparin during surgery whereas second group did not receive any anticoagulation. Post-operative complications and outcome of surgery were compared between the two groups. Among 50 patients, 25 received heparin and 25 did not. Although there was no significant difference in operative times between these two groups (p = 0.24), early post-operative bleeding complication was more common in patients receiving heparin (p < 0.01). The primary 6-week patency was 96.0% for patients receiving heparin and 92.0% for those not (p = 0.46). Thus per-operative systemic anticoagulation during vascular access surgery is associated with increased incidence of bleeding complication and offers no benefit in terms of primary patency