Clopidogrel Diminishes Hemodialysis Access Graft Thrombosis

Department of Medicine, Hospital Británico, Buenos Aires, Argentina.
Nephron Clinical Practice (Impact Factor: 1.4). 02/2006; 102(3-4):c128-32. DOI: 10.1159/000089671
Source: PubMed


The most common complication of hemodialysis (HD) access graft is thrombosis. Clopidogrel, an inhibitor of platelet aggregation, was assessed to prevent this serious complication.
A prospective study in which 24 patients on chronic HD whose vascular accesses were grafts were divided into two groups: group A (n = 12, 50%) consisted of patients who did not receive antithrombotic therapy after graft creation, and group B (n = 12, 50%) received clopidogrel 75 mg/day from 2 days after surgery onwards. Both groups were not different according to age, gender, cause of renal failure, hematocrit levels, platelet counts and Kt/V. All patients' thrombotic episodes were followed up from the day of graft surgery until thrombosis was diagnosed. Finally, the patient survival difference between both groups was determined.
Eleven thrombotic episodes were diagnosed in group A while one event was reported in group B (p < 0.001). Graft access days of patency were significantly longer in group B compared to group A (380.8 +/- 170 vs. 90.1 +/- 57.2, p < 0.001). Time that elapsed from dialysis initiation to graft creation was not different (group A 18 +/- 12 days, group B 20 +/- 10 days). Days on HD were different between both groups (group A 208.9 +/- 97.2 vs. group B 583.2 +/- 287.0, p < 0.001) and all patients from group A (n = 12, 100%) and 2 patients from group B (16.7%) died (p = 0.001). Major bleeding events were not reported.
Clopidogrel significantly decreased thrombotic graft episodes. Patients on clopidogrel had a prolonged vascular access patency, longer time on HD and better survival.

Download full-text


Available from: Hernan Trimarchi, Oct 07, 2015
22 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this review will be to summarize recent concepts pertaining to the pathophysiology of dialysis access stenosis and to then use this information to highlight novel interventions (both diagnostic and therapeutic) for dialysis access dysfunction. The studies covered in this review will include experimental and observational studies in addition to clinical trials. An important biological focus of this review will be an emphasis on the role of the adventitia and progenitor cells in the pathogenesis of dialysis access dysfunction. The main interventional focus will be on access surveillance, local drug delivery and other novel therapeutic interventions. An important underlying theme throughout this review will be an emphasis on arteriovenous fistulae and on the many advantages of local therapeutic interventions in the specific clinical setting of dialysis access dysfunction. Vascular access dysfunction remains a significant cause of morbidity and mortality for hemodialysis patients. We believe that a better understanding of the biological mechanisms of vascular access stenosis will help guide the development of novel therapies to prevent and treat dialysis access stenosis.
    Current Opinion in Nephrology and Hypertension 12/2007; 16(6):516-22. DOI:10.1097/MNH.0b013e3282efa57f · 3.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or an A-V interposition prosthetic shunt for haemodialysis. To determine the effects of adjuvant drug treatment on the patency of fistulae and grafts in patients with ESRD who are undergoing haemodialysis by assessing the number of thrombotic episodes. The Cochrane Peripheral Vascular Diseases Group (PVD) searched their Specialised Register (last searched May 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2). RCTs of active drug versus placebo in patients with ESRD undergoing haemodialysis via an A-V fistula or prosthetic interposition A-V graft. For the update, two review authors (ADS, GO) independently assessed trial quality and ADS, XE, and GO extracted data. Information on adverse events was collected from the trials. The outcome measure analysed was the long-term fistula or graft patency rate. The overall results of the meta-analysis (three RCTs) comparing aspirin versus placebo favoured treatment with aspirin (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.20 to 0.86; P = 0.02).The overall result of the meta-analysis ( three RCTs) comparing ticlopidine (a platelet aggregation inhibitor) versus placebo favoured active treatment (OR 0.47, 95% CI 0.26 to 0.85; P = 0.01).The overall result from one trial comparing the effect of dipyridamole versus placebo and dipyridamole plus aspirin versus placebo favoured treatment (OR 0.57, 95% CI 0.13 to 2.51; OR 0.77, CI 0.19 to 3.19, respectively).One trial compared fish oil (4 g/daily) versus placebo with 24 participants, follow-up 12 months. The overall result favoured treatment (OR 0.07, 95% CI 0.01 to 0.49).One trial compared low-dose warfarin with placebo, 107 patients were followed for 37 months but the trial was terminated prematurely due to increased bleeding events in the treatment group. The overall result favoured placebo (OR 1.76, 95% CI 0.78 to 3.99).One trial compared sulfinpyrazone versus placebo. Sixteen patients, follow-up three months, and the overall result favoured treatment (OR 0.14, 95% CI 0.01 to 1.99).Finally, one trial compared clopidogrel (75 mg/once daily) with placebo. Twenty-four patients, follow-up over a three-year period until their first episode of thrombosis. The overall result favoured treatment (OR 0.01, 95% CI 0.00 to 0.15). The meta-analysis confirmed the beneficial effect of anti-platelet treatment as an adjuvant used to increase the patency of A-V fistulae and grafts in the short term.
    Cochrane database of systematic reviews (Online) 02/2008; 2008(4):CD002786. DOI:10.1002/14651858.CD002786.pub2 · 6.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Maintenance of a functioning vascular access for hemodialysis is a major challenge for nephrologists, vascular surgeons and--most importantly--the patients themselves. Greater insight into the pathophysiology of access thrombosis, stenosis, aneurysm formation, fistula maturation failure and catheter infection will aid the development of innovative ways to prevent and treat these complications. According to the results of observational studies, agents that decrease the release of inflammatory mediators, improve endothelial function, and inhibit the migration and proliferation of vascular smooth-muscle cells might improve the maturation and survival of native hemodialysis fistulas and synthetic hemodialysis grafts by reducing the risks of thrombosis and stenosis. Currently available drugs that interfere with metalloproteinases could prevent the formation of aneurysms, and bacterial quorum sensing offers a promising target for the prevention of biofilm infection in hemodialysis catheters.
    Nature Clinical Practice Nephrology 10/2008; 4(11):628-38. DOI:10.1038/ncpneph0947 · 6.08 Impact Factor
Show more