From the Research
Long-term anticoagulation after dialysis fistula declotting in patients with End-Stage Renal Disease (ESRD) undergoing dialysis is not typically recommended due to the increased risk of bleeding complications, and instead, daily aspirin (81-325 mg) is often considered as the primary recommendation. This regimen should begin immediately after successful declotting and continue indefinitely unless contraindicated. Some patients may benefit from clopidogrel (75 mg daily) as an alternative if aspirin-intolerant, or in addition to aspirin in high-risk cases.
Key Considerations
- The use of warfarin is generally not recommended for routine use due to bleeding risks and monitoring requirements, though it may be considered in patients with recurrent thrombosis despite antiplatelet therapy, as seen in a study published in 2021 1.
- A study published in 2022 found that anticoagulation therapy was associated with a higher rate of wound infections but did not affect short-term access patency within six-months 2.
- Another study published in 2024 highlighted the increased risks of both bleeding and thrombosis in chronic HD patients with AF, particularly those on combined anticoagulation and antiplatelet therapy 3.
Anticoagulation Strategy
The anticoagulation strategy aims to prevent rethrombosis by inhibiting platelet aggregation at the site of endothelial injury. This is particularly important in the first few months after declotting when the risk of recurrent thrombosis is highest.
Monitoring and Education
Regular monitoring of the fistula function through physical examination (checking for thrill and bruit) is essential regardless of the anticoagulation regimen chosen. Patients should also be educated about signs of fistula dysfunction, such as decreased thrill, absence of bruit, or swelling, which warrant immediate medical attention.
Prioritizing Morbidity, Mortality, and Quality of Life
In making this recommendation, the priority is to minimize morbidity, mortality, and improve quality of life for patients with ESRD undergoing dialysis, as supported by the most recent and highest quality study available 3.