Comparison of Efficacy of Arteriovenous Fistula (AVF) Creation in Chronic Renal Failure for Hemodialysis Access — Using vs Not Using Subcutaneous Low-Molecular-Weight Heparin (LMWH): A Randomized Controlled Trial

Arteriovenous fistula (AVF) creation is the preferred vascular access for hemodialysis, yet early failure rates remain high—often 20–50 percent—mainly due to early thrombosis and poor maturation. These complications delay effective dialysis, increase reliance on temporary catheters, and lead to higher morbidity and healthcare costs. Low-molecular-weight heparin (LMWH) may reduce perioperative thrombosis by improving vessel patency during the critical early postoperative period. However, existing evidence is limited, inconsistent, and lacks rigorous randomized trials, particularly regarding safety concerns such as bleeding or hematoma formation. A well-designed randomized controlled study is therefore necessary to determine whether perioperative LMWH can improve early AVF patency and maturation without increasing complications. This trial aims to generate reliable data to guide clinical practice and optimize outcomes for patients requiring hemodialysis access.