Systemic Heparin Use in Upper Extremity Arteriovenous Access Maintenance for Dialysis: A Meta-Analysis of Randomized Studies.

BACKGROUND: A significant proportion of arteriovenous fistulas (AVFs) and grafts for hemodialysis fail due to early thrombosis, necessitating reintervention. The role of systemic heparinization in improving perioperative patency remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of perioperative systemic heparin on the patency of upper-limb vascular access creations (fistulas or grafts placement).

METHODS: We searched PubMed, Embase, and Cochrane databases for randomized trials comparing heparinization versus standard care in adults undergoing arm AVF or graft placement. Data were pooled using a random-effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager 5.4.

RESULTS: Six studies comprising 1,265 patients were included, of whom 731 (58%) underwent heparinization. Systemic heparinization significantly reduced the odds of early patency loss compared to standard care (OR: 0.58; 95% CI: 0.37-0.92; P = 0.02; I2 = 14%). However, heparin was associated with an increased risk of bleeding complications (OR: 4.24; 95% CI: 1.13-15.9; P = 0.13; I2 = 47%).

CONCLUSION: Perioperative systemic heparinization significantly improves early patency rates for hemodialysis vascular access in adults undergoing arm fistulization or graft placement; however, there is a risk of increased bleeding events. Heparin may be considered a viable preventive strategy against early thrombosis, though its use should be balanced against individual patient bleeding risk and surgical considerations.