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Antiplatelets may reduce vascular access thrombosis among hemodialysis recipients
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Antiplatelet agents such as aspirin may reduce the rate of vascular access thrombosis among hemodialysis patients, according to results of a retrospective cohort study published in the Journal of Thrombosis and Hemostasis.
However, researchers did not observe this observation with warfarin.
“Vascular access is also known as a ‘lifeline’ for patients receiving hemodialysis. The patency and rate of blood flow of vascular access are directly associated with dialysis adequacy," P.Y. Fan, MD, of the department of nephrology at Chang Gung Memorial Hospital in Taiwan, and colleagues wrote. “Complications associated with vascular access result in frequent hospitalizations and often require intervention. These complications have significant impacts on the morbidity and mortality of dialysis patients, while also leading to high medical costs.”
Fan and colleagues sought to determine the effects of different antiplatelet agents and oral anticoagulants on the vascular failure rates of arteriovenous fistulas or arteriovenous grafts in hemodialysis patients, as well as the rate of major bleeding.
The researchers assessed 95,971 patients with end-stage renal disease enrolled in the Taiwan National Health Insurance program between 1997 and 2012. All patients received hemodialysis with arteriovenous fistulas (AVF) or arteriovenous grafts (AVG) for vascular access. Patients defined as having an AVF or AVG failure/thrombosis included those who received thrombectomy or percutaneous angioplasty. The researchers defined major bleeding as an ED visit or hospitalization for gastrointestinal bleeding or intracerebral hemorrhage.
Results showed the following ORs for vascular access failure of 0.21 (95% CI, 0.11-0.39) for aspirin; 0.76 (95% CI, 0.74-0.79) for clopidogrel; 0.67 (95% CI, 0.59-0.77) for dipyridamole; 0.67 (95% CI, 0.53-0.86) for Aggrenox (aspirin and dipyridamole, Boehringer Ingelheim); and 0.96 (95% CI, 0.9-1.03) for warfarin.
The investigators then assessed whether the antiplatelet medications or oral anticoagulants were protective in terms of vascular patency. They also further stratified patients into subgroups according to gender and age.
Warfarin provided a protective effect only among patients older than 50 years (OR = 0.92; 95% CI, 0.86-0.99).
Younger patients using Aggrenox had the highest OR for intracerebral hemorrhage (5.33; 95% CI, 1.25-22.72). Researchers also observed a higher risk for intracerebral hemorrhage with warfarin use (OR = 1.36; 95% CI, 1.01-1.84) and among patients aged older than 50 years (OR = 1.4; 95% CI, 1.02-1.91).
There appeared to be no significant difference in bleeding risk by gender among these groups, and no other antiplatelet agents significantly increased intracerebral hemorrhage risk.
The aspirin treatment group experienced no GI tract bleeding events. Clopidogrel had the highest OR for gastrointestinal bleeding (1.34; 95% CI, 1.10-1.64), followed by warfarin (1.3; 95% CI, 0.79-2.12), Aggrenox (0.75; 95% CI, 0.1-5.36) and dipyridamole (0.42; 95% CI, 0.11-1.7). Only clopidogrel increased GI tract bleeding, particularly among older patients (OR = 1.3; 95% CI, 1.06-1.6) and women (OR = 1.41; 95% CI, 1.08-1.84).
“Antiplatelet agents, including aspirin, clopidogrel and dipyridamole, might reduce the rate of AVF or AVG failure,” the researchers wrote. “Aspirin was an effective agent in preventing arteriovenous shunt failure without increasing the rate of GI bleeding. However, the GI bleeding rate was increased with concomitant use of clopidogrel. The combination of aspirin and dipyridamole may increase the rate of intracerebral hemorrhage in younger patients. Taking warfarin did not reduce the rate of AVF or AVG failure but increased the rate of intracerebral hemorrhage in our patients.” – by Jennifer Byrne
Disclosures: The researchers report no relevant financial disclosures.
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