Combined aspirin and sulfinpyrazone in the prevention of recurrent hemodialysis vascular access thrombosis

Dt, Domoto; Je, Bauman; Jh, Joist

doi:10.1016/0049-3848(91)90377-9

Cited by 34 publications

(25 citation statements)

References 16 publications

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“…9 Several smaller studies have also reported a beneficial effect of aspirin or clopidogrel on hemodialysis graft patency. [12][13][14] Compared with these prior vascular access studies, this study had the largest number of participants on aspirin and the reduction in the adjusted hazard ratio for loss of primary unassisted graft patency (17%) was similar to the prior studies (16 to 22%). 9 -11 Collectively, these studies suggest that aspirin may be effective in prolonging primary patency of hemodialysis grafts.…”

Section: Discussionmentioning

confidence: 67%

Use of Aspirin Associates with Longer Primary Patency of Hemodialysis Grafts

Dixon¹,

Beck²,

Dember³

et al. 2011

Journal of the American Society of Nephrology

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Extended-release dipyridamole plus low-dose aspirin (ERDP/ASA) prolongs primary unassisted graft patency of newly created hemodialysis arteriovenous grafts, but the individual contributions of each component are unknown. Here, we analyzed whether use of aspirin at baseline associated with primary unassisted graft patency among participants in a randomized trial that compared ERDP/ASA and placebo in newly created grafts. We used Cox proportional hazards regression, adjusting for prespecified baseline comorbidities and covariates. Of all participants, 43% reported use of aspirin at baseline; of these, 82% remained on nonstudy aspirin (i.e., excluding ERDP/ASA) at 1 year. After 1 year of follow-up, the incidence of primary unassisted patency among participants using aspirin at baseline was 30% (95% CI: 24 to 35%) and among those not using aspirin was 23% (95% CI: 18 to 27%). Use of aspirin at baseline associated with a dose-dependent prolongation of primary unassisted graft patency that approached statistical significance (adjusted HR, 0.83; 95% CI: 0.68 to 1.01; P ϭ 0.06). Use of aspirin at baseline did not associate with prolongation of cumulative graft patency or participant survival. In conclusion, use of aspirin associates with a trend toward longer primary unassisted patency of newly placed hemodialysis grafts similar to that observed for ERDP/ASA.

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Section: Discussionmentioning

confidence: 67%

Use of Aspirin Associates with Longer Primary Patency of Hemodialysis Grafts

Dixon¹,

Beck²,

Dember³

et al. 2011

Journal of the American Society of Nephrology

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“…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

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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.

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“…Small studies of aspirin and sulfinpyrazone (10), dipyridamole (11), and ticlopidine (12) demonstrated the effectiveness of those agents in the prevention of graft thrombosis. In the study of aspirin and sulfinpyrazone, 15 patients with bovine carotid artery grafts received those agents in a nonrandomized, nonblinded, crossover design (10). The frequency of thrombosis was reduced from 0.114 episodes/mo in the observation period to 0.04 episodes/mo during drug treatment.…”

mentioning

confidence: 99%

Randomized Controlled Trial of Clopidogrel plus Aspirin to Prevent Hemodialysis Access Graft Thrombosis

Kaufman¹,

O’Connor²,

Zhang³

et al. 2003

Journal of the American Society of Nephrology

215

145

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ABSTRACT. Thrombosis of hemodialysis vascular access grafts represents a major medical and economic burden. Experimental and clinical models suggest a role for antiplatelet agents in the prevention of thrombosis. The study was designed to determine the efficacy of the combination of aspirin and clopidogrel in the prevention of graft thrombosis. The study was a randomized, double-blind trial conducted at 30 hemodialysis units at Veterans Affairs medical centers. Participants undergoing hemodialysis with a polytetrafluoroethylene graft in the arm were randomized to receive either double placebos or aspirin (325 mg) and clopidogrel (75 mg) daily. Participants were to be monitored while receiving study medications for a minimum of 2 yr. The study was stopped after randomization of 200 participants, as recommended by the Data Safety and Monitoring Board because of a significantly increased risk of bleeding among the participants receiving aspirin and clopidogrel therapy. The cumulative incidence of bleeding events was significantly greater for those participants, compared with participants receiving placebos [hazard ratio, 1.98; 95% confidence interval (CI), 1.19 to 3.28; P = 0.007]. Twenty-three participants in the placebo group and 44 participants in the active treatment group experienced a bleeding event (P = 0.006). There was no significant benefit of active treatment in the prevention of thrombosis (hazard ratio, 0.81; 95% CI, 0.47 to 1.40; P = 0.45), although there was a trend toward a benefit among participants who had not experienced previous graft thrombosis (hazard ratio, 0.52; 95% CI, 0.22 to 1.26; P = 0.14). In the hemodialysis population, therapy with aspirin and clopidogrel was associated with a significantly increased risk of bleeding and probably would not result in a reduced frequency of graft thrombosis. E-mail: james.kaufman@med.va.gov

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Combined aspirin and sulfinpyrazone in the prevention of recurrent hemodialysis vascular access thrombosis

Cited by 34 publications

References 16 publications

Use of Aspirin Associates with Longer Primary Patency of Hemodialysis Grafts

Use of Aspirin Associates with Longer Primary Patency of Hemodialysis Grafts

Antiplatelet Medications in Hemodialysis Patients

Randomized Controlled Trial of Clopidogrel plus Aspirin to Prevent Hemodialysis Access Graft Thrombosis

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