Experience with the drug streptokinase thrombosis arteriovenous fistulas
Science Articles / / August 12, 2017
Yakubov LY, Ramodin EI Erlenekov SS
City Clinical Hospital №1, Tolyatti
pharmacological thrombolysis in the early stages (up to three days) after thrombosis of arteriovenous fistulas in patients receiving chronic hemodialysis outpatient program (HAPGD), is of great practical importance in the work of any department of hemodialysis.Preservation of native arteriovenous fistula is especially desirable for patients with mild vessels in the upper limbs, making it difficult to form a new vascular access.In all cases, after the formation of arteriovenous fistula on the other end, it requires a certain period of time for its "maturation" (from two weeks to one month).During this period, for the continuation of dialysis is necessary to resort to the formation of a temporary vascular access - staged double-lumen catheter in the central vein (usually in the subclavian).All this often leads to undesirable complications - phlebitis followed by stenosis of the veins, infectious complications until sepsis.
purpose of this article - learn from the experiences of conservative treatment of thrombosis of arteriovenous fistulas in patients with ESRD in the hemodialysis unit.Arteriovenous fistula thrombosis - a frequent complication in the practice of any branch of hemodialysis.We have fourteen such cases noted in two years.
Factors contributing to thrombosis veins fistula are:
- excessively tight bandaging of the forearm at the puncture site, which leads to a slowing of blood flow in the fistula until it stops (two cases);
- hypotension with the slowing of blood flow in the fistula caused by, mostly excessive ultrafiltration during hemodialysis (six cases);
- hematoma in the field of unsuccessful punctures the fistula vein, with its compression (two cases);
- stenosis of the main trunk of the vein fistula (one case);
- severe heart rhythm disorders (one case);
- with no established cause (two cases).
In 11 cases conducted conservative treatment.For the pharmaco thrombolytic drug streptokinase we used.In / in the introduction of streptokinase started with a test dose of 300 thousand. EF jet.In the absence of side effects h / h h / drip injected 2700000 EF preparation for 3-4 hours.In case the patient was administered thrombolysis fraxiparine 2850 ME twice a day for a week.The results of treatment were as follows:
- in eight cases was observed positive effect (thrombolysis with full restoration of blood flow);
- not marked effect in two cases;
- in one case, expressed the reaction after administration of a test dose of streptokinase, served as the refusal of its application.
Of the eight successful cases, one patient developed a thrombosis repeated, the remaining patients fistula continue to operate in two months.
Duration functional safety fistula after thrombolysis was pharmacochemical:
- more than one year - 1;
- more than six months - 2;
- more than three months - 2;
- up to three months - 3.
According to the obtained data, we came to the conclusion that the first three days after thrombosis arteriovenous fistula appropriate, in the absence of contraindications, prescriptions streptokinase at a dose of 1.5-3 million EF, followed by the appointment of anticoagulantsdirect action (fraxiparine, heparin) during the week with the aim of preventing retrombosis.In our opinion, will reduce the frequency of surgical interventions on the formation of secondary native arteriovenous fistulas.