Intern Emerg Med. 2025 Nov 4. doi: 10.1007/s11739-025-04182-0. Online ahead of print.
ABSTRACT
Hemodialysis patients have an increased risk of bleeding related to platelet dysfunction and uremia leading to acquired defects in primary hemostasis. Frequently, these patients have multiple medical comorbidities requiring treatment with antiplatelet agents and anticoagulants, further increasing their bleeding risk. This presents added challenges when they present to the emergency department (ED) with arteriovenous fistula or arteriovenous graft (AVF/AVG) bleeding. This retrospective cohort study aims to characterize patient characteristics, mortality outcomes, hemorrhage outcomes, infectious outcomes, repeat ED visits, non-invasive procedures, and invasive procedures associated with ED encounters for AVF/AVG bleeding. This is a retrospective cohort study evaluating ED encounters for patients on hemodialysis with a chief complaint of a bleeding AVF/AVG. Descriptive statistics as well as logistic regression were used to find correlations between patient and encounter factors and the risk of requiring an advanced procedure to prevent further AVF/AVG bleeding. The primary outcome was the need for a formal intervention to revascularize or perform angioplasty on the patient’s AVF or AVG. This occurred in 173 (50.7%) encounters. A history of any bleeding event was associated with the primary outcome while a higher initial platelet count or the use of antiplatelets were inversely associated with the primary outcome. This multi-center retrospective cohort study evaluated patient and clinical characteristics in encounters involving AVF/AVG bleeding. Correlating factors between ED encounters involving AVF/AVG bleeding and the need for advanced AVF/AVG interventions are described. Further research with a larger, more diverse patient base is needed to confirm these findings before these characteristics can be considered indications for more rapid interventional radiology or vascular surgery follow up in cases of AVF/AVG bleeding.
PMID:41186888 | DOI:10.1007/s11739-025-04182-0
