Gan, Chye Chung and Tan, Ru Yu and Cheong, May Anne and Pang, Suh Chien and Tng, Ren Kwang Alvin and Tan, Chee Wooi and Lee, Lai Heng and Ng, Heng Joo and Tay, Kiang Hiong and Chong, Tze Tec and Tan, Chieh Suai (2024) Efficacy and safety of low dose, weight-based subcutaneous enoxaparin protocol in recurrent arteriovenous access thrombosis. Journal of Vascular Access, 25 (6). pp. 1982-1988. ISSN 1129-7298, DOI https://doi.org/10.1177/11297298231194102.
Full text not available from this repository.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 preversus 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.
| Item Type: | Article |
|---|---|
| Funders: | UNSPECIFIED |
| Uncontrolled Keywords: | Recurrent arteriovenous access thrombosis; enoxaparin; lower molecular weight heparin; access patency; thrombectomy and thrombolysis; dialysis access; thromboprophylaxis; AV fistula; prosthetic grafts |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine > Medicine Department |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 16 Jan 2025 03:48 |
| Last Modified: | 16 Jan 2025 03:48 |
| URI: | http://eprints.um.edu.my/id/eprint/47670 |
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