Patency of arteriovenous fistula for dialysis improbe with topical spraygel heparin.
OBJECTIVE
Vascular access for hemodialysis can be provided by a native arteriovenous fistula (AVF), a synthetic arteriovenous graft (AVG), or a central venous catheter. The mature, native fistula is considered the preferred type of vascular access. This study evaluates the results of a retrospective registry assessing topically applied heparin (added to antiplatelet therapy) efficacy in patients with newly created AVF.


METHODS
To the current "best treatment", a number of patients also added topical heparin spray, a formulation containing a high concentration of heparin sodium for topical administration. At present, the average followup time is 7.9 months (range 3-12).


RESULTS
In all patients using topical heparin, AVF remained patent and suitable for dialysis at three months. One fistula occluded at six months, and one more become unsuitable for dialysis. In patients using only antiplatelets, three fistulas occluded at three months and another two at six months of follow-up. In all, after six months of follow-up, there were two patients using heparin for whom the dialysis access was not suitable for dialysis; in the group treated with antiplatelets only, the access could not be used any longer in six patients. Addition of heparin reduced the risk for patency loss by 16.7% at three months and by 22.2% at six months. The risk of reduced dialysis suitability of the fistula was reduced by 27.6% and 22.2%, respectively. The odds for the loss of fistula patency and dialysis suitability at six months follow-up in patients treated with antiplatelet versus combined treatment was 6.5 and 4, respectively. Also, the number of patients needed to treat (NNT) with the addition of heparin spray to achieve AVF patency and suitability at three and/or six months suggests the benefit of combined adjuvant medical treatments for prevention of early AV shunt failure. The safety and tolerability of both treatments were good.


CONCLUSIONS
Considering these results, it appears that topically applied heparin may sustain AVF patency and suitability for dialysis.
Stuard
S
S
Irvine3 Labs, Department Biomedical Sciences, Chieti-Pescara University, Pescara, Italy.
Belcaro
G
G
Dugall
M
M
Cesarone
M R
MR
Hosoi
M
M
Errichi
B M
BM
Ippolito
E
E
Bavera
P
P
Cornelli
U
U
D000328:Adult; D001164:Arteriovenous Fistula / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D013927:Thrombosis / Q000628:therapy; D016896:Treatment Outcome; D014654:Vascular Patency
D010975:Platelet Aggregation Inhibitors; D006493:Heparin