Abstract:

Objective To study the effect, therapeutic course and related factors of local urokinase application for the treatment of thrombosis in arteriovenous fistula in hemodialysis patients. Methods Local injection of urokinase was used in 28 hemodialysis patients for the treatment of thrombosis in fistula. Colored Doppler ultrasonography, hepatic and renal functions, prothrombin time and plasma fibrinogen were measured before and after the treatment. Results The thrombolytic treatment was used for the 28 cases in a total of 44 times, of which 32 times (72.7%) showed successful results. The proportion of male and climacteric female patients was higher in the successful cases than in the unsuccessful patients. Shorter thrombosis time and less mural thrombosis were found in the successful cases. However, thrombosis recurred in 53.13% of the successful patients. Recurrence of thrombosis was related to mural thrombosis and their complicated diseases, and was frequently seen in diabetic patients. When urokinase was used in a dose of less than 60,000 IU, successful results were found in 81.3% cases, and in 96.9% cases whose blocked fistula lasted less than 36 hours. In 2 cases, thrombosis recurred after opening of the blocked fistula for 16-48 hours. The usual side effects of urokinase were subcutaneous hemorrhage, epistaxis, and gingival bleeding, but gastrointestinal and cerebral bleeding were not encountered. Conclusion Urokinase is an effective thrombolytic measure for hemodialysis patients with thrombosis in autologous arteriovenous fistula. Its effectiveness is related to the existing time of thrombosis, the presence of mural thrombosis and the complication of diabetes. Urokinase is used in a dose of less than 60,000 IU. Thrombolysis treatment must be performed within 24-36 hours after the occurrence of thrombosis. After the treatment, patients should be observed for 72 hours. After reopening of the fistula, urokinase and low molecular heparin in the dose for maintenance therapy can prevent the fistula from thrombosis recurrence.

Key words: Arteriovenous fistulae, Thrombolysis, Thrombus