The Effect of Systemic Anticoagulation in Patients Undergoing Angioaccess Surgery

Objective: The benefit of intravenous heparin as an anticoagulant to avoid thrombotic complications during angioaccess surgery for hemodialysis is unknown. We undertook this study to determine the value of routine, systemic anticoagulation in patients undergoing vascular access and the effect of this practice on procedural outcomes.
Methods: We prospectively randomized 115 consecutive patients referred to our institution for permanent hemodialysis access to receive systemic anticoagulation or no anticoagulation during angioaccess surgery from July 2004 to March 2006. Based on preoperative imaging studies, patients were selected for autogenous arteriovenous fistulas or prosthetic arteriovenous grafts. Patient demographics, comorbid conditions, procedure time, complications, and patency were recorded in accordance with standards recommended by the Society for Vascular Surgery.
Results: 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-value 0.31). Perioperative bleeding complications were more common in patients receiving heparin (p-value 0.008). The primary 30-day patency was 84% for patients receiving heparin and 86% for those not (p-value 0.79). The 3-month functional patency was 68% for both groups (p-value 0.99). Age, gender, operative time, and incidence of bleeding complications had no impact on patency.
Conclusion: Systemic anticoagulation for angioaccess surgery is associated with an increased incidence of bleeding complications and offers no advantage in terms of patency.