A systematic review and meta-analysis of systemic intraoperative anticoagulation during arteriovenous access formation for dialysis

Smith, George E.; Souroullos, Panos; Cayton, Thomas; Harwood, Amy; Carradice, Daniel; Chetter, Ian C.

Abstract

Purpose: Surgical arteriovenous fistula (AVF) or graft (AVG) is preferred to a central venous catheter for dialysis access. Surgical access may suffer thrombosis early after placement and systemic anticoagulation during surgical access formation may increase patency rates but would be expected to increase bleeding-related complications. A systematic review and meta-analysis of randomised controlled trials was conducted to examine the impact of systemic anticoagulation on access surgery perioperative bleeding and patency rates. Methods: We included randomised controlled trials testing systemic anticoagulation during access formation versus a control group without systemic anticoagulation reporting bleeding complications and access patency. Medline, Embase, CENTRAL and CINAHL were searched up to March 2015. Risk of bias was assessed using the Cochrane risk of bias tool and the Jadad score. Meta-analysis was performed using Cochrane Revman ® software. Results: Searches identified 445 reports of which four randomised studies involving 411 participants were included. Three studies pertained to AVF only and one included both AVF and AVG. Systemic anticoagulation led to increased bleeding events in all access [four trials; risk ratio (RR) 7.18; confidence interval (CI), 2.41 to 21.38; p < 0.001]. Patency was not improved for all access (four trials; RR, 0.64; CI, 0.37 to 1.09; p = 0.10) but was improved when AVF analysed alone (three trials; RR, 0.57; CI, 0.33 to 0.97; p = 0.04). Conclusions: The use of intraoperative systemic anticoagulation during access formation is associated with a highly significant increased risk of bleeding-related complications. A significant improvement in AVF patency was seen, though not when AVF and AVG were analysed together.

Citation

Smith, G. E., Souroullos, P., Cayton, T., Harwood, A., Carradice, D., & Chetter, I. C. (2016). A systematic review and meta-analysis of systemic intraoperative anticoagulation during arteriovenous access formation for dialysis. The journal of vascular access, 17(1), 1-5. https://doi.org/10.5301/jva.5000484

• Journal Article Type: Article
• Acceptance Date: Sep 20, 2015
• Online Publication Date: Jul 12, 2015
• Publication Date: Jan 1, 2016
• Deposit Date: Nov 18, 2015
• Publicly Available Date: Nov 23, 2017
• Journal: Journal of vascular access
• Print ISSN: 1129-7298
• Electronic ISSN: 1724-6032
• Publisher: Wichtig
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 1
• Pages: 1-5
• DOI: https://doi.org/10.5301/jva.5000484
• Keywords: Anticoagulants, Arteriovenous fistula, Graft occlusion (vascular), Heparin, Vascular surgical procedures
• Public URL: https://hull-repository.worktribe.com/output/381549
• Publisher URL: http://www.vascular-access.info/article/a-systematic-review-and-meta-analysis-of-systemic-intraoperative-anticoagulation-during-arteriovenous-access-formation-for-dialysis
• Additional Information: This is the author's accepted manuscript of an article which has been published in: Journal of vascular access, 2016, v.17 issue 1.