PMID- 20063059
OWN - NLM
STAT- MEDLINE
DCOM- 20110923
LR  - 20211020
IS  - 1573-2584 (Electronic)
IS  - 0301-1623 (Linking)
VI  - 43
IP  - 2
DP  - 2011 Jun
TI  - Use of enoxaparin to diminish the incidence of vascular access 
      stenosis/thrombosis in chronic hemodialysis patients.
PG  - 499-505
LID - 10.1007/s11255-009-9703-1 [doi]
AB  - BACKGROUND: Enoxaparin, a low molecular weight heparin, has been shown to be a 
      safe and effective anticoagulant to prevent clotting in the extracorporeal 
      circulation during hemodialysis. Enoxaparin also possesses antiproliferative 
      properties, and reduces neointimal proliferation following vascular injury in 
      animals. Use of enoxaparin during hemodialysis may be associated with decreased 
      myointimal proliferation and diminished vascular access stenosis or failure. AIM: 
      The aim of our study was to test the efficacy of enoxaparin to reduce the 
      incidence of recurrent vascular access stenosis in chronic hemodialysis patients. 
      METHODS: Twenty-nine hemodialysis patients who suffered from recurrent 
      arteriovenous (A-V) access stenosis were studied retrospectively to compare the 
      incidence of vascular access procedures before and during enoxaparin 
      administration. Enoxaparin was administered intravenously as a single bolus at 
      the start of hemodialysis. RESULTS: Twenty-eight patients (14 male) were 
      analyzed. Ten required a new fistula during the study period. Observed treatment 
      times (years/patient) were 1.20 +/- 0.87 for unfractionated heparin (UFH) and 3.04 
      +/- 2.19 for enoxaparin (P = 0.0001). Angiographic procedure rates 
      (procedures/year) were 1.76 +/- 0.92 in the UFH group and 1.30 +/- 1.01 in the 
      enoxoparin group (P = 0.0786). There were no significant differences in time to 
      first stenosis between the two groups (P = 0.5315). One patient receiving 
      enoxaparin developed upper gastrointestinal bleeding and a second patient 
      sustained a subdural hematoma after a fall. CONCLUSION: Our study demonstrated a 
      trend toward a decreased number of angiographic procedures for maintaining A-V 
      access patency in selected chronic hemodialysis patients treated with enoxaparin 
      in comparison with UFH as anticoagulant during dialysis.
FAU - Shavit, Linda
AU  - Shavit L
AD  - Division of Adult Nephrology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 
      91031, Israel. lshavit@szmc.org.il
FAU - Lifschitz, Meyer
AU  - Lifschitz M
FAU - Lee, Shuko
AU  - Lee S
FAU - Slotki, Itzchak
AU  - Slotki I
LA  - eng
PT  - Journal Article
DEP - 20100110
PL  - Netherlands
TA  - Int Urol Nephrol
JT  - International urology and nephrology
JID - 0262521
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Arteriovenous Shunt, Surgical/*adverse effects
MH  - Constriction, Pathologic/etiology/prevention & control
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - *Renal Dialysis
MH  - Retrospective Studies
MH  - Thrombosis/etiology/*prevention & control
EDAT- 2010/01/12 06:00
MHDA- 2011/09/29 06:00
CRDT- 2010/01/12 06:00
PHST- 2009/10/19 00:00 [received]
PHST- 2009/12/28 00:00 [accepted]
PHST- 2010/01/12 06:00 [entrez]
PHST- 2010/01/12 06:00 [pubmed]
PHST- 2011/09/29 06:00 [medline]
AID - 10.1007/s11255-009-9703-1 [doi]
PST - ppublish
SO  - Int Urol Nephrol. 2011 Jun;43(2):499-505. doi: 10.1007/s11255-009-9703-1. Epub 
      2010 Jan 10.