Journal article
Primary thromboprophylaxis with heparins for arteriovenous fistula failure in pediatric patients
The journal of vascular access, Vol.8(4), pp.235-244
10/01/2007
DOI: 10.1177/112972980700800404
PMID: 18161668
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 I 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.
Details
- Title: Subtitle
- Primary thromboprophylaxis with heparins for arteriovenous fistula failure in pediatric patients
- Creators
- A. Sharathkumar - University of Michigan–Ann ArborR. Hirschl - University of Michigan–Ann ArborS. Pipe - University of Michigan–Ann ArborC. Crandell - University of Michigan–Ann ArborB. Adams - University of Michigan–Ann ArborJ. J. Lin - East Carolina University
- Resource Type
- Journal article
- Publication Details
- The journal of vascular access, Vol.8(4), pp.235-244
- Publisher
- Sage
- DOI
- 10.1177/112972980700800404
- PMID
- 18161668
- ISSN
- 1129-7298
- eISSN
- 1724-6032
- Number of pages
- 10
- Language
- English
- Date published
- 10/01/2007
- Academic Unit
- Stead Family Department of Pediatrics; Hematology/Oncology
- Record Identifier
- 9984354044102771
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