The effect of systemic anticoagulation in patients undergoing angioaccess surgery
The effect of systemic anticoagulation in patients undergoing angioaccess surgery
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DOI：
10.1016/j.avsg.2007.09.002
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发表时间：
2008-01-01
影响因子：
1.5
通讯作者：
Wise, Leslie
中科院分区：
文献类型：
--
作者：
D'Ayala, Marcus;Smith, Robina M.;Wise, Leslie
静脉注射肝素作为抗凝剂在血液透析血管通路手术中避免血栓并发症的益处尚不清楚。我们前瞻性地随机选择115例连续的患者转到我们的机构进行永久性血液透析，在血管插管手术期间接受全身抗凝或不进行抗凝。根据血管外科学会推荐的标准记录患者人口统计、合并症、手术时间、并发症和通畅度。在随机分组的115例患者中，58例未接受抗凝治疗，57例接受全身静脉肝素抗凝治疗。84例患者建立动静脉瘘，31例植入动静脉移植物。移植物的手术时间比瘘管长，但接受抗凝治疗和未接受抗凝治疗的患者手术时间无显著差异（p = 0.31）。肝素组围手术期出血并发症更为常见（p = 0.008）。接受肝素治疗的患者最初30天通畅率为84%，未接受肝素治疗的患者为86% （p = 0.79）。两组3个月功能通畅率均为68% （p = 0.99）。年龄、性别、手术时间、出血并发症发生率对通畅性无影响。根据我们的经验，血管插管手术的全身抗凝与出血并发症的发生率增加有关，并且在早期通畅方面没有优势。
The benefit of intravenous heparin as an anticoagulant to avoid thrombotic complications during angioaccess surgery for hemodialysis is unknown. We prospectively randomized 115 consecutive patients referred to our institution for permanent hemodialysis access to receive systemic anticoagulation or no anticoagulation during angioaccess surgery. Patient demographics, comorbid conditions, procedure time, complications, and patency were recorded in accordance with standards recommended by the Society for Vascular Surgery. Of the 115 patients randomized, 58 received no anticoagulation and 57 received systemic anticoagulation with intravenous heparin. Arteriovenous fistulas were created in 84 patients and 31 arteriovenous grafts were inserted. Operative times were longer for grafts compared to fistulas, but there were no significant differences in operative times between patients receiving anticoagulation and those not (p = 0.31). Perioperative bleeding complications were more common in patients receiving heparin (p = 0.008). The primary 30-day patency was 84% for patients receiving heparin and 86% for those not (p = 0.79). The 3-month functional patency was 68% for both groups (p = 0.99). Age, gender, operative time, and incidence of bleeding complications had no impact on patency. In our experience, systemic anticoagulation for angioaccess surgery is associated with an increased incidence of bleeding complications and offers no advantage in terms of early patency.