Efficacy and safety of low dose, weight-based subcutaneous enoxaparin protocol in recurrent arteriovenous access thrombosis.

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  • Additional Information
    • Source:
      Publisher: Sage Publications Country of Publication: United States NLM ID: 100940729 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1724-6032 (Electronic) Linking ISSN: 11297298 NLM ISO Abbreviation: J Vasc Access Subsets: MEDLINE
    • Publication Information:
      Publication: 2018- : Thousand Oaks, CA : Sage Publications
      Original Publication: Milano ; Birmingham : Wichtig, c2000-
    • Subject Terms:
      Enoxaparin*/administration & dosage ; Enoxaparin*/adverse effects ; Vascular Patency* ; Recurrence* ; Thrombosis*/etiology ; Thrombosis*/physiopathology ; Thrombosis*/prevention & control ; Arteriovenous Shunt, Surgical*/adverse effects ; Anticoagulants*/administration & dosage ; Anticoagulants*/adverse effects ; Renal Dialysis* ; Graft Occlusion, Vascular*/etiology ; Graft Occlusion, Vascular*/physiopathology ; Thrombectomy*/adverse effects ; Fibrinolytic Agents*/administration & dosage ; Fibrinolytic Agents*/adverse effects; Humans ; Male ; Female ; Aged ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Time Factors ; Risk Factors ; Injections, Subcutaneous
    • Abstract:
      Background: This study aims to evaluate the safety and efficacy of a short-term, low dose, weight-based subcutaneous enoxaparin protocol (SEP) in maintaining the patency of arteriovenous (AV) access with recurrent thrombosis.
      Methods: Prospective follow-up of 25 patients who presented to a tertiary institution with recurrent AV access thrombosis and treated with anticoagulation according to SEP following successful thrombectomy. Patency and safety outcomes of SEP were studied.
      Results: The participants were 66.4 ± 10.2 years old and predominantly male (60%) and of Chinese ethnicity (72%). The AV accesses had a median age of 1.4 (0.6, 5.6) years with 60% being non-autogenous arteriovenous access while 40% were autogenous arteriovenous access. Thrombolytic agents (urokinase (72%) or alteplase (28%)) were used in all procedures while adjunct thrombectomy device was used in only four procedures. The mean dose of enoxaparin was 36.0 ± 8.2 mg or 0.64 ± 0.1 mg/kg/day for a mean duration 30.0 days (Interquartile range: 27.5, 31.0). One patient developed minor bleeding episode. Kaplan-Meier analysis demonstrated that the mean thrombosis-free survival pre- versus post-SEP adoption was 27.3 (95% CI 17.9-36.7) versus 183.5 (95% CI 100.1-266.9) days ( p  < 0.001). After adjusting for the type of thrombolytic agent, use of adjunct thrombectomy device, cutting balloon, drug-coated balloon, and stent graft, SEP remained a significant factor associated with longer thrombosis-free patency (HR 0.166: 95% CI 0.070-0.392, p  < 0.001).
      Discussion: SEP appears to be a feasible and safe thromboprophylaxis method to improve thrombosis-free patency for AV access with recurrent thrombosis.
      Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
    • Contributed Indexing:
      Keywords: AV fistula; Recurrent arteriovenous access thrombosis; access patency; dialysis access; enoxaparin; lower molecular weight heparin; prosthetic grafts; thrombectomy and thrombolysis; thromboprophylaxis
    • Accession Number:
      0 (Enoxaparin)
      0 (Anticoagulants)
      0 (Fibrinolytic Agents)
    • Publication Date:
      Date Created: 20230920 Date Completed: 20241106 Latest Revision: 20241106
    • Publication Date:
      20241106
    • Accession Number:
      10.1177/11297298231194102
    • Accession Number:
      37726986