Irvine3 Labs, Department Biomedical Sciences, Chieti-Pescara University, Pescara, Italy.
Panminerva Med. 2010 Jun;52(2 Suppl 1):33-6.
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.
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).
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.
Considering these results, it appears that topically applied heparin may sustain AVF patency and suitability for dialysis.
血液透析的血管通路可以通过天然动静脉瘘（AVF）、合成动静脉移植物（AVG）或中心静脉导管提供。成熟的天然瘘被认为是首选的血管通路类型。本研究评估了一项回顾性登记研究的结果，该研究评估了局部应用肝素（联合抗血小板治疗）在新建立的 AVF 患者中的疗效。
在目前的“最佳治疗”基础上，一些患者还添加了局部肝素喷雾，这是一种含有高浓度肝素钠的局部制剂。目前，平均随访时间为 7.9 个月（范围 3-12 个月）。
所有使用局部肝素的患者在三个月时 AVF 仍然保持通畅且适合透析。一个瘘管在六个月时闭塞，另一个瘘管变得不适合透析。仅使用抗血小板治疗的患者中，三个瘘管在三个月时闭塞，另两个在六个月时闭塞。在所有患者中，在六个月的随访后，有两名患者使用肝素的透析通路不再适合透析；在仅接受抗血小板治疗的组中，有六名患者的通路不再可用。肝素的添加使三个月时的通畅性丧失风险降低了 16.7%，六个月时的风险降低了 22.2%。瘘管的透析适应性降低风险分别降低了 27.6%和 22.2%。在接受抗血小板治疗与联合治疗的患者中，六个月时瘘管通畅性和透析适应性丧失的比值比分别为 6.5 和 4。此外，在三个月和/或六个月时添加肝素喷雾以实现 AVF 通畅性和透析适应性的治疗需要人数（NNT）表明，联合辅助药物治疗预防早期 AV 分流失败具有益处。两种治疗方法的安全性和耐受性均良好。
考虑到这些结果，局部应用肝素可能会维持 AVF 的通畅性和透析适应性。
