Randomized controlled trial of clopidogrel to prevent primary arteriovenous fistula failure in hemodialysis patients

Abstract

The optimal vascular access for chronic maintenance hemodialysis is the arteriovenous fistula (AVF). Several studies suggest a role for antiplatelet agents in the prevention of primary AVF failure. A double-blind, randomized trial was conducted to assess the efficacy and safety of clopidogrel in hemodialysis patients. Ninety three patients were randomized to receive 75 mg/daily of clopidogrel or placebo. The treatment was initiated 7–10 days prior to scheduled access surgery and continued up to six weeks postoperatively, and then patients were monitored for six months. The primary outcome was AVF failure eight weeks after fistula creation. With a permuted block randomization schedule, 46 patients received clopidogrel and 47 patients received control placebo. The primary AVF failures at two months were 21.6% in placebo group and 5.2% in clopidogrel group (P = 0.03). The hazard ratio for the incidence of primary AVF failure was 0.72 (CI 95%, 0.41–1.01). Analysis of covariables indicated that this effect occurred principally as a result of clopidogrel administration. First hemodialysis from newly created AVF in clopidogrel group was significantly more successful than placebo group (P = 0.008). No life-threatening adverse event or severe bleeding was recorded in both groups. Clopidogrel seems to be effective and safe for prevention of primary AVF failure in hemodialysis patients.

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

“…23 During surgery, traction of the arteries can lead to postoperative vasospasm, decreased blood flow, and endovascular damage. 24,25 These factors contribute to formation of thrombus after fistula formation, which results in failure of internal fistula function. 14 A recent study reported by Kim et al.…”

Oral prostacycline analog and clopidogrel combination provides early maturation and long-term survival after arteriovenous fistula creation: A randomized controlled study

“…There have been a few small trials evaluating pharmacological agents aimed at reducing the early thrombosis rate. [ 8 13 14 15 ]. These trials utilized the antiplatelet agents, aspirin, sulphinpyrazone, and clopidogrel and varied in size from as few as 5 patients up to 250 patients.…”

“…[ 8 10 17 ] In view of these postulated mechanisms of AVF failure, possible clinical benefit of antiplatelet therapy has been proposed for prevention of AVF failure. [ 13 14 16 ]…”

The role of antiplatelet therapy on arteriovenous fistula malfunctioning among hemodialysis patients

“…A native fistula is the ideal type of access as the risk of complications and need for interventions are at lowest, and it also provides a longterm patency. 6 Nevertheless, a major obstacle in the long-term success of hemodialysis therapy is AVF dysfunction. 5 In AVF creation, the best method to decrease the risk of primary AVF failure involves introducing hemodialysis vascular access early, performing vascular mapping, and assessing newly created AVFs at four weeks.…”