Effect of Apixaban on early anastomotic stenosis after arteriovenous fistula creation for hemodialysis

Background: The maturation and patency of arteriovenous fistula (AVF) are crucial in patients requiring hemodialysis (HD). Although several trials have been conducted to evaluate the impact of various medications on AVF maturation, little has been observed. Apixaban, a direct oral anticoagulant, has been shown to have a protective effect against intimal hyperplasia (IH). We therefore aimed to determine the effect of Apixaban on the patency, maturation, and anastomotic size of AVF after creation. Methods: This two-center randomized study included all patients who underwent AVF creation between July 2023 and November 2024. The primary outcome was AVF maturation. Secondary outcomes were complications and mortality. Patients were divided randomly into two groups. The first group (treatment group, N = 44) received Apixaban 2.5 mg twice daily, while the second group (control group, N = 48) received no treatment. A Doppler ultrasound was performed for measurement of anastomotic size, vein diameter, and flow volume based on subsequent fistula adequacy. Autogenous AVFs were constructed with end to side anchor technique anastomosis as distally as possible in all patients. Both groups were followed‑up for 6 months. Results: Ninety two patients underwent AVF creation during the study period. After 6 months follow up, the primary patency in the Apixaban group was 90.9%, while it was 79.2% in the control group ( p = 0.117). The incidence of anastomotic stenosis was significantly lower in the Apixaban group compared to the control group (9.1% vs 29.2%, p = 0.015). A thrombosis event was reported in three cases (6.8%) and nine cases (18.8%), in Apixaban and control groups respectively ( p = 0.09). Patients who received Apixaban encountered a total of ten bleeding episodes (one major and nine minor incidents), accounting for 22.7% of the group ( p = 0.11). It is important to highlight that none of these incidents led to fatalities. Conclusion: Apixaban might be beneficial for decreasing early AVF maturation failure in patients requiring HD.