Observation of the effect of urokinase thrombolysis combined the guide wire fragmentation and low molecular heparin anticoagulation for the treatment of arteriovenous fistula embolization

Abstract

Objective To analyze the curative effect used the common urokinase thrombolysis combined with topo-guide-wire fragmentation and low molecular heparin in the treatment of hemodialysis patients with arteriovenous fistula embolization and explore the prospects of its application. Methods 30 hemodialysis patients with arteriovenous fistula embolization were divided into 15 cases of thrombolysis group and 15 cases of thrombectomy group according to the voluntary. The thrombolysis group was given simple urokinase thrombolysis, and the thrombectomy group was given thrombectomy combined with anticoagulant therapy. The curative effect and the difference in complication were compared. Results In curative effect, the recanalization rate,using time after recanalization, and dosage of urokinase of the thrombectomy group were better than those of the thrombolysis group[13cases vs.7cases,(22.13± 17.51)months vs.(11.05±10.55)months,(40.48±22.26)ten thousands IU vs.(60.29±15.81)ten thousands IU,χ2 =5.40,t=2.10,all P 0.05).For the thrombectomy group,there were fewer cases of re-embolization after recanalization(2 cases/13 cases vs.4 cases/7 cases,χ2=3.85,P<0.05),but more cases of organ embolism(4 cases vs.0 cases,χ2=4.62,P<0.05). Conclusion Compared with the traditional urokinase thrombolytic therapy, the guide wire fragmentation combined with low molecular weight heparin anticoagulant therapy has a higher fistula recanalization rate and a lower re-embolization rate.It does not increase the incidence of bleeding complications.Besides,it can extend the use of internal fistula.However,it may cause the serious organ embolism,so it is necessary to strictly grasp the indications,applying only to the patients who are in the poor efficiency of thrombolytic and unable to have another operation. Key words: Hemodiafiltration; Arteriovenous fistula; Thrombolytic therapy; Urokinase; Low molecular heparin