End-stage renal disease (ESRD) is a growing global health burden, and the creation of a native arteriovenous fistula (AVF) is the gold standard for vascular access in patients requiring hemodialysis \[1\]. AVFs offer superior longevity, fewer infectious complications, and lower mortality rates compared to central venous catheters or synthetic grafts \[2\]. However, a significant limitation to their widespread success is the high rate of early failure, primarily due to failure to mature (FTM). FTM occurs in 20-40% of AVFs, rendering them unusable for dialysis \[3\].
Apixaban, a direct factor Xa inhibitor, offers a potential advantage by providing sustained anticoagulation throughout the critical maturation period \[7\]. Its predictable pharmacokinetics, oral administration, and favorable safety profile make it an attractive agent for short-term use in this setting \[8\]. By reducing microthrombotic events during the first 4-6 weeks following AVF creation, apixaban could potentially improve maturation rates. However, this potential benefit must be weighed against the increased risk of bleeding, hematoma formation, and wound complications that could negatively impact fistula maturation \[9\].
Age ≥ 18 years.
Diagnosis of ESRD (eGFR < 15 mL/min/1.73m² or already on dialysis) with plans for hemodialysis.
Planned primary upper extremity AVF creation (radiocephalic, brachiocephalic, or brachiobasilic).
Suitable vessels on preoperative duplex ultrasound (artery ≥ 2 mm, vein ≥ 2.5 mm without tourniquet).
Known bleeding diathesis or hypercoagulable state.
Current therapeutic anticoagulation (any indication).
Current dual antiplatelet therapy.
History of intracranial hemorrhage.
Parallel
Apixaban
DrugApixaban 2.5mg BD given postoperatively for 6 weeks to intervention arm
AV Fistula Maturation
As per standard definitions
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