Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheter (TCC) thrombosis

Colì, L.; Donati, Gabriele; Cianciolo, Giuseppe; Raimondi, Concettina; Comai, Giorgia; Panicali, Laura; Nastasi, Valentina; Cannarile, Daniela Cecilia; Gozzetti, Francesco; Piccari, Matteo; Stefoni, Sergio

doi:10.1177/112972980600700305

Cited by 51 publications

(48 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prophylactic warfarin has shown some effect in reducing thrombus formation rates in patients with a TDC (49 -51). The importance of adequate systemic anticoagulation (international normalized ratio, 1.5 to 2.0) is crucial (49). Malfunction-free catheter survival at 9 months was 47.1% in patients with adequate anticoagulation compared with 8.1% in patients without (P ϭ 0.01).…”

Section: Managing Thrombotic Access Dysfunction With Anticoagulants Amentioning

confidence: 96%

Catheter Management in Hemodialysis Patients

Besarab

Pandey²

2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryOver 330,000 individuals in the United States depend on hemodialysis (HD), the majority as a result of endstage renal disease. Sustainable vascular access can be achieved through arteriovenous fistulas, arteriovenous grafts, or tunneled catheters. Tunneled dialysis catheters (TDCs) often remain in use for months or even years, long beyond their initial intended use as a bridging device. Research efforts are focused on identifying strategies to prevent/minimize the risk of the most common catheter-related complications: thrombotic occlusion and infection. Thrombotic occlusion of TDCs prevents adequate dialysis but can be managed successfully through thrombolytic agents to restore/improve blood flow in the majority of patients, allowing immediate HD delivery and prolonging usability of the TDC. Occasionally, catheter exchange with fibrin sheath disruption is needed to preserve the site. Surface-treated catheters could improve the morbidity and mortality associated with HD delivery via an indwelling catheter, but results from studies have been disappointing to date. We review the etiology of catheter-based access failure and the monitoring and interventional steps that should be taken to maintain the patency and safety of catheters for HD. Wherever possible we note the areas in which there is scant data where further randomized clinical trials are needed.

show abstract

Section: Managing Thrombotic Access Dysfunction With Anticoagulants Amentioning

confidence: 96%

Catheter Management in Hemodialysis Patients

Besarab

Pandey²

2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…The bleeding risk with sulfinpyrazone (18), ticlopidine (19,21) and clopidogrel (28) does not appear to be increased when used in patients on hemodialysis compared with patients treated with placebo or control, even when used in combination with warfarin (29).…”

Section: Antiplatelet Agents and Bleeding Riskmentioning

confidence: 99%

Antiplatelet Medications in Hemodialysis Patients

Hiremath

Holden

Fergusson³

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: Patients with end stage renal disease (ESRD) are often prescribed antiplatelet medications. However, these patients are also at increased risk of bleeding compared with the general population, and an aim was made to quantify this risk with antiplatelet agents.Design, setting, participants, & measurements: A systematic review of the literature (Medline, EMBASE, Cochrane CEN-TRAL and Google Scholar databases) was done to determine the bleeding risk in ESRD patients prescribed antiplatelet therapy. The secondary outcome was the effect on access thrombosis. All case series, cohort studies and clinical trials were considered if they included ten or more ESRD patients, assessed bleeding risk with antiplatelet agents, and lasted for more than 3 mo.Results: Sixteen studies, including 40,676 patients, were identified that met predefined inclusion criteria. Due to study heterogeneity and weaknesses in methodology, bleeding rates were not pooled across studies. However, the bleeding risk appears to be increased for hemodialysis patients treated with combination antiplatelet therapy. The results are mixed for studies using a single antiplatelet agent. Antiplatelet agents appear to be effective in preventing shunt and central venous catheter thrombosis, but not for preventing thrombosis of arteriovenous grafts.Conclusion: The risks and benefits of antiplatelet agents in ESRD patients remain poorly defined. Until a clinical trial addresses this in the dialysis population, individual risk stratification taking into account the increased risk of bleeding should be considered before initiating antiplatelet agents, especially in combination therapy.

show abstract

“…Additionally, we found that the use of dual or triple AP agents was associated with a significant increase in the risk of hemorrhagic events compared with no use of an anti-thrombosis agent (HR:2.03, p = 0.049, Table 4). The results of randomized trials [16-18] and those of an earlier study [21] and the present observational study are not easily reconciled, presumably due to differences in clinical profiles of the study subjects. However, the results of the present study support the notion that clinical benefits of a combination of AP agents and those of the combination of an AP agent with WF are partly cancelled by an increase in hemorrhagic events in HD patients.…”

Section: Discussionmentioning

confidence: 57%

“…reported that the incidence of gastrointestinal hemorrhage was not significantly different among four antiplatelet regimens (dipyridamole, aspirin, dipyridamole plus aspirin, no drug control) in HD patients with a graft arterio-venous shunt (n = 107). Coli et al [18]. randomized 144 HD patients into a ticlopidine group and a WF plus ticlopidine group and found no significant difference between the two groups in hemorrhagic events during 12 months of follow-up.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of the Number of Anti-Thrombosis Agents in Hemodialysis Patients: BOREAS-HD2 Study

Tanaka

Moniwa

Ohnishi

et al. 2017

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Relationships between the number of anti-thrombosis agents, clinical benefits and adverse events in hemodialysis (HD) patients are unclear. Methods: All patients on HD in 22 institutes (n = 1,071) were enrolled and followed up for 3 years. After exclusion of patients with missing data, kidney transplantation or retraction of consent during the follow-up period (n = 204), mortality rate and ischemic and hemorrhagic events were compared between different regimens of anti-thrombosis agents. Results: The use of dual or triple antiplatelet (AP) agents (HR:2.03, 95% CI:1.01-4.13, p = 0.04) and the combination of an AP agent and warfarin (WF) (HR:4.84, 95%CI 1.96-11.96, p < 0.001) were associated with an increase in hemorrhagic events compared with no use of anti-thrombosis agents. No anti-thrombosis regimen was associated with a significant change in risk of ischemic stroke. The use of dual or triple AP agents, but not WF, was associated with an increase in cardiovascular mortality (HR:2.48, 95% CI:1.24-4.76, p = 0.01). Conclusion: A significant increase in hemorrhagic events by the use of dual or more AP agents and by co-administration of an AP agent and WF in patients on HD should be considered in planning their anti-thrombosis regimen.

show abstract

Anticoagulation therapy for the prevention of hemodialysis tunneled cuffed catheter (TCC) thrombosis

Cited by 51 publications

References 16 publications

Catheter Management in Hemodialysis Patients

Catheter Management in Hemodialysis Patients

Antiplatelet Medications in Hemodialysis Patients

Impact of the Number of Anti-Thrombosis Agents in Hemodialysis Patients: BOREAS-HD2 Study

Contact Info

Product

Resources

About