Objective,2,To observe the effect of low dose urokinase combined with four-step massage on autogenous arteriovenous fistula （AVF） thrombosis and explore its mechanism.,Methods,2,A total of 86 patients with AVF thrombosis admitted to Xingtai People's Hospital from March 2020 to May 2021 were selected and divided into observation group and control group by random number table method with 43 cases in each group.The control group was given routine thrombolytic therapy with high-dose urokinase，while the observation group was given low-dose urokinase combined with four-step massage，and the treatment course of both groups was no more than 3 days.The thrombolytic effect of 2 groups was observed， the levels of coagulation function indexes ［activated partial prothrombin time （APTT），prothrombin time （PT），plasma fibrinogen （FIB），D-dimer （D-D）］，plasma C-reactive protein （CRP），soluble endothelial cell protein C receptor （sEPCR） and high mobility group protein B1 （HMGB1） were compared between the two groups before and after treatment.Treatment related side effects were recorded in 2 groups.,Result,2,Compared with the control group，the observation group had higher internal fistula recirculation rate，shorter internal fistula lysis time，larger internal diameter at the orifice fistula，and higher initial dialysis blood flow after dissolution，with statistical significance （,P,<,0.05）.After treatment，APTT and PT in 2 groups were longer than that before treatment，and plasma FIB and D-D，CRP，sEPCR and HMGB1 levels were lower than that before treatment， with statistical significance （,P,<,0.05）.After treatment，the above indexes in the observation group changed more significantly than that in the control group （,P,<,0.05）.The incidence of adverse events in observation group was lower than that in control group （,P,<,0.05）.No serious adverse events such as thrombus loss，allergic reaction，intracranial hemorrhage and visceral hemorrhage occurred in the 2 groups，and no abnormalities were observed in other safety indicators.,Conclusion,2,The thrombolytic effect of low-dose urokinase combined with four-step massage in the treatment of AVF thrombosis is better than that of conventional thrombolytic therapy with high-dose urokinase，which can improve the thrombolytic effect and reduce the adverse reactions of urokinase.The mechanism of action may be related to improving coagulation function and down-regulation of CRP，sEPCR and HMGB1 levels.