Beraprost sodium versus clopidogrel for preventing vascular thromboembolic events of arteriovenous fistula in uraemic patients: a retrospective study with a mean 3-year follow-up

Abstract

Objective This study aimed to evaluate the efficacy of beraprost sodium (BPS) or clopidogrel (CL) using vascular thromboembolic events (VTEs) of arteriovenous fistula as a primary endpoint in patients with end-stage renal disease (ESRD) undergoing arteriovenous fistula surgery. Methods We performed a multicentre, retrospective cohort study from August 2012 to August 2016. We studied patients with ESRD who underwent arteriovenous fistula surgery and received peroral administration of 40 µg BPS, three times per day, for 1 month, or 75 mg CL (initial dose of 300 mg), one time per day, for 1 month. The time to first on-study VTE was the primary endpoint. Results The BPS-treated cohort had a significantly delayed time to first VTE compared with the CL-treated cohort (hazard ratio 0.33, 95% confidence interval 0.18–0.56). An increased incidence of VTEs was detected in the 1-month follow-up, with rates of 2.4% and 8.7% for BPS and CL, respectively. This difference persisted over time, with rates of 8.0% and 18.1% at the final follow-up, respectively. Conclusion CL-treated patients with ESRD have a greater risk of VTEs compared with BPS-treated patients. CL-treated patients also tend to experience a VTE within the first month after cessation of oral administration.

Expert consensus on the establishment and maintenance of native arteriovenous fistula

“…We reviewed nine studies on the application of beraprost sodium in maintenance HD patients after AVF surgery ( Supplementary Table 1 ). 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 A prospective study in South Korea found that the use of beraprost sodium in maintenance HD patients significantly improved the 2-year patency rate of vascular access and prolonged the patency time. Multivariate analysis demonstrated that the use of beraprost sodium can reduce the risk of loss of vascular access by 42% (HR = 0.580, 95% CI: 0.068–0.982, P = 0.047), while aspirin has no benefit for vascular access.…”