Effect of Apiban Therapy on AVF Maturation in ESRD Patients

Summary

End-stage renal disease (ESRD) is a growing global health burden, and the creation of a native arteriovenous fistula (AVF) is the gold standard for vascular access in patients requiring hemodialysis \[1\]. AVFs offer superior longevity, fewer infectious complications, and lower mortality rates compared to central venous catheters or synthetic grafts \[2\]. However, a significant limitation to their widespread success is the high rate of early failure, primarily due to failure to mature (FTM). FTM occurs in 20-40% of AVFs, rendering them unusable for dialysis \[3\]. Apixaban, a direct factor Xa inhibitor, offers a potential advantage by providing sustained anticoagulation throughout the critical maturation period \[7\]. Its predictable pharmacokinetics, oral administration, and favorable safety profile make it an attractive agent for short-term use in this setting \[8\]. By reducing microthrombotic events during the first 4-6 weeks following AVF creation, apixaban could potentially improve maturation rates. However, this potential benefit must be weighed against the increased risk of bleeding, hematoma formation, and wound complications that could negatively impact fistula maturation \[9\].

Timeline

Start

2026-01-01

Primary completion

2026-06-30

Completion

2026-08-31

Publications

• Background Wang BR, Rowe VL, Ham SW, Han S, Patel K, Weaver FA, Woo K. A prospective clinical evaluation of the effects of intraoperative systemic anticoagulation in patients undergoing arteriovenous fistula surgery. Am Surg. 2010 Oct;76(10):1112-4. doi: 10.1177/000313481007601020.
• Background Bhomi KK, Shrestha S, Bhattachan CL. Role of systemic anticoagulation in patients undergoing vascular access surgery. Nepal Med Coll J. 2008 Dec;10(4):222-4.
• Background Ebrahimifard F. Effect of intraoperative intravenous injection of heparin on patency rate of radiocephalic autogenous arteriovenous fistula in chronic renal failure patients. Arch Crit Care Med. 2015;1(2):e1528.
• Background Mozafar M, Hoseinzadegan F, Lotfollahzadeh S, et al. Effects of heparin on early patency of arteriovenous fistula in angioaccess surgery of patients with end-stage renal disease. Intern Med Med Investig J. 2018;3(1):36.
• Background Aimanan K, Idris M, Suryani L, et al. Does systemic heparin reduce thrombosis rate of radiocephalic fistula: double-blinded randomized study. Vasc Dis Ther. 2017;2(6):1-5.
• Background Douketis JD, Spyropoulos AC. Perioperative Management of Patients Taking Direct Oral Anticoagulants: A Review. JAMA. 2024 Sep 10;332(10):825-834. doi: 10.1001/jama.2024.12708.
• Background Bristol-Myers Squibb, Pfizer. Eliquis® (apixaban) prescribing information. 2024.
• Background Ravari H, Kazemzade GH, Sarookhani A, Khashayar P. Effect of heparin on the patency of arteriovenous fistula. Acta Med Iran. 2008;46(5):379-382.
• Background D'Ayala M, Smith RM, Martone C, Briggs W, Deitch JS, Wise L. The effect of systemic anticoagulation in patients undergoing angioaccess surgery. Ann Vasc Surg. 2008 Jan;22(1):11-5. doi: 10.1016/j.avsg.2007.09.002. Epub 2007 Dec 4.
• Background Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Collins R, Camm AJ, Heidbuchel H; ESC Scientific Document Group. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018 Apr 21;39(16):1330-1393. doi: 10.1093/eurheartj/ehy136.
• Background Byon W, Garonzik S, Boyd RA, Frost CE. Apixaban: A Clinical Pharmacokinetic and Pharmacodynamic Review. Clin Pharmacokinet. 2019 Oct;58(10):1265-1279. doi: 10.1007/s40262-019-00775-z.
• Background Bahi M. Effect of Systemic Intraoperative Heparin Use on Upper Extremity Arteriovenous Fistula Patency in End-Stage Renal Disease Patients. ScientificWorldJournal. 2021 Oct 31;2021:2965743. doi: 10.1155/2021/2965743. eCollection 2021.
• Background Smith GE, Souroullos P, Cayton T, Harwood A, Carradice D, Chetter IC. A systematic review and meta-analysis of systemic intraoperative anticoagulation during arteriovenous access formation for dialysis. J Vasc Access. 2016 Jan-Feb;17(1):1-5. doi: 10.5301/jva.5000484. Epub 2015 Dec 7.
• Background Rothuizen TC, Wong C, Quax PH, van Zonneveld AJ, Rabelink TJ, Rotmans JI. Arteriovenous access failure: more than just intimal hyperplasia? Nephrol Dial Transplant. 2013 May;28(5):1085-92. doi: 10.1093/ndt/gft068. Epub 2013 Mar 29.
• Background Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, Himmelfarb J, Vazquez MA, Gassman JJ, Greene T, Radeva MK, Braden GL, Ikizler TA, Rocco MV, Davidson IJ, Kaufman JS, Meyers CM, Kusek JW, Feldman HI; Dialysis Access Consortium Study Group. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA. 2008 May 14;299(18):2164-71. doi: 10.1001/jama.299.18.2164.
• Background Quencer KB, Arici M. Arteriovenous Fistulas and Their Characteristic Sites of Stenosis. AJR Am J Roentgenol. 2015 Oct;205(4):726-34. doi: 10.2214/AJR.15.14650.
• Background Malovrh M. Strategy for the maximal use of native arteriovenous fistulae for hemodialysis. ScientificWorldJournal. 2006 Jul 14;6:808-15. doi: 10.1100/tsw2006.171.

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