Preventing arteriovenous shunt failure in hemodialysis patients: a population‐based cohort study. (24th December 2018)

• Record Type: Journal Article
• Authors: Fan, P. Y.; Lee, C. C.; Liu, S. H.; Li, I.‐J.; Weng, C. H.; Tu, K. H.; Hsieh, M. Y.; Kuo, C. F.; Chang, T.‐Y.; Tian, Y. C.; Yang, C. W.; Wu, H. H.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 17:Number 1(2019)
• Page Start: 77
• Page End: 87
• Publication Date: 2018-12-24
• Subjects: antiplatelet agents -- arteriovenous fistula -- end‐stage renal disease -- hemorrhage -- thrombosis -- warfarin; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.14347
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract : Essentials Uncertainty remains about antiplatelets for vascular access patency in hemodialysis patients. 95 971 people under hemodialysis were followed in a claims database in Taiwan. Aspirin reduced vascular access failure rate and did not increase major bleeding rate. Clopidogrel, Aggrenox, and warfarin might increase major bleeding rate. Summary: Background: Dialysis adequacy is a major determinant of survival for patients with end‐stage renal disease. Good vascular access is essential to achieve adequate dialysis. Objectives: This study evaluated the impacts of different drugs on the vascular access failure rate of an arteriovenous fistula or an arteriovenous graft and the rate of major bleeding in hemodialysis patients. Patients and methods: We studied patients with end‐stage renal disease registered in the Taiwan National Health Insurance program from 1 January 1997 to 31 December 2012. A total of 95 971 patients were enrolled in our study. Vascular access dysfunction was defined as the need for thrombectomy or percutaneous angioplasty. Major bleeding was defined as emergency department visits or hospitalization with a primary diagnosis of gastrointestinal bleeding or intracerebral hemorrhage. The adjusted odds ratios between person‐quarters with or without antiplatelet or oral anticoagulant use were calculated using a generalized estimating equation. Results: The odds ratio of vascular access failure was 0.21 (0.11–0.39) for aspirin, 0.76 (0.74–0.79) for clopidogrel, 0.67 (0.59–0.77) for dipyridamole, 0.67 (0.53–0.86) for Aggrenox and 0.96 (0.90–1.03) for warfarin. The highest odds ratio for intracerebral hemorrhage was 5.33 (1.25–22.72) in younger patients using Aggrenox. The highest odds ratio for gastrointestinal bleeding was 1.34 (1.10–1.64) for clopidogrel. Conclusion: Antiplatelet agents, but not warfarin, might reduce the vascular access thrombosis rate. The gastrointestinal bleeding rate was increased in the group using clopidogrel. Aggrenox should be used with caution in young individuals because it might increase the rate of intracerebral hemorrhage.