Antiplatelet Therapy to Prevent Hemodialysis Vascular Access Failure: Systematic Review and Meta-analysis

Palmer, Suetonia C.; Micco, Lucia Di; Razavian, Mona; Craig, Jonathan C.; Ravani, Pietro; Perkovic, Vlado; Tognoni, Gianni; Graziano, Giusi; Jardine, Meg; Pellegrini, Fabio; Nicolucci, Antonio; Webster, Angela C; Strippoli, Giovanni F.M.

doi:10.1053/j.ajkd.2012.08.031

Cited by 92 publications

(83 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No trends in major bleeding episodes were observed among patients receiving DES. Our results are largely consistent with a recent meta‐analysis of 21 trials in 4826 patients on hemodialysis, which showed that patients randomized to receive an antiplatelet agent for acute coronary syndromes after undergoing PCI had no significant increased risk of major bleeding (relative risk 0.93, CI 0.58 to 1.49) compared with control . However, only 34% of these patients were in trials including a thienopyridine; the other antiplatelet agents used included aspirin, sulfinpyrazone, or dipyridamole.…”

Section: Discussionsupporting

confidence: 89%

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Chang

Montez‐Rath

Shen

et al. 2014

JAHA

View full text Add to dashboard Cite

BackgroundCoronary stenting in patients on dialysis has increased by nearly 50% over the past decade, despite heightened risks of associated stent thrombosis and bleeding relative to the general population. We examined clopidogrel, prasugrel or ticlopidine use after percutaneous coronary intervention (PCI) with stenting in patients on dialysis. We conducted 3‐, 6‐, and 12‐month landmark analyses to test the hypothesis that thienopyridine discontinuation prior to those time points would be associated with higher risks of death, myocardial infarction, or repeat revascularization, and a lower risk of major bleeding episodes compared with continued thienopyridine use.Methods and ResultsUsing the US Renal Data System, we identified 8458 patients on dialysis with Medicare Parts A+B+D undergoing PCI with stenting between July 2007 and December 2010. Ninety‐nine percent of all thienopyridine prescriptions were for clopidogrel. At 3 months, 82% of patients who received drug‐eluting stents (DES) had evidence of thienopyridine use. These proportions fell to 62% and 40% at 6 and 12 months, respectively. In patients who received a bare‐metal stent (BMS), 70%, 34%, and 26% of patients had evidence of thienopyridine use at 3, 6, and 12 months, respectively. In patients who received a DES, there was a suggestion of higher risks of death or myocardial infarction associated with thienopyridine discontinuation in the 3‐, 6‐, and 12‐months landmark analyses, but no higher risk of major bleeding episodes. In patients who received a BMS, there were no differences in death or cardiovascular events, and possibly lower risk of major bleeding with thienopyridine discontinuation in the 3‐ and 6‐month landmark analyses.ConclusionsThe majority of patients on dialysis who undergo PCI discontinue thienopyridines before 1 year regardless of stent type. While not definitive, these data suggest that longer‐term thienopyridine use may be of benefit to patients on dialysis who undergo PCI with DES.

show abstract

Section: Discussionsupporting

confidence: 89%

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Chang

Montez‐Rath

Shen

et al. 2014

JAHA

View full text Add to dashboard Cite

show abstract

“…The best evidence currently available to guide treatment in the setting of ESRD is inconclusive, particularly for people with ESRD who are young or have atrial fibrillation, highlighting a lack of good-quality randomized, controlled data. One metaanalysis found that antiplatelet agents had no effect on the risk of having a stroke, with uncertain effects on the risk of bleeding (including having a hemorrhagic stroke) in people with ESRD (20). Another meta-analysis found that statins had no effect on lowering the risk of stroke in people with ESRD, despite lowering cholesterol (21).…”

Section: Discussionmentioning

confidence: 99%

Risk of Stroke in Patients with ESRD

Masson

Kelly

Craig

et al. 2015

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

Background and objectives This study aimed to determine absolute and excess stroke risks in people with ESRD compared with the general population.Design, setting, participants, & measurements This cohort study used data linkage between the Australia and New Zealand Dialysis and Transplant Registry and hospital and death records for 10,745 people with ESRD in New South Wales from 2000 to 2010. For the general population, Australian Institute of Health and Welfare hospital usage records and Australian Bureau of Statistics census data were used. Rates and standardized incidence rate ratios of hospitalization with a stroke were calculated.Results People with ESRD had 640 hospitalizations with stroke in 49,472 person-years of follow-up (1294 per 100,000 person-years), and people in the general population had 338,392 hospitalizations with stroke (212 per 100,000 person-years), an incidence rate ratio of 3.32 (95% confidence interval, 3.31 to 3.33). Excess risk was greater for women (incidence rate ratio, 5.14; 95% confidence interval, 5.11 to 5.18) than men (incidence rate ratio, 2.52; 95% confidence interval, 2.51 to 2.54; P for interaction ,0.001) and decreased with age. People ages 35-39 years old with ESRD had an 11 times increased risk of stroke (incidence rate ratio, 11.08; 95% confidence interval, 9.41 to 13.05), and risk in people ages $85 years old increased 2-fold (incidence rate ratio, 2.04; 95% confidence interval, 1.87 to 2.23; P for interaction ,0.001). Excess risk was greater for intracerebral hemorrhage (incidence rate ratio, 4.18; 95% confidence interval, 4.11 to 4.26) than ischemic stroke (incidence rate ratio, 3.43; 95% confidence interval, 3.40 to 3.45; P for interaction ,0.01).Conclusions People with ESRD have a substantially higher risk of stroke, particularly women and young people, and hemorrhagic stroke. Future work could investigate effective and safe interventions for primary and secondary prevention of stroke in people with ESRD.

show abstract

“…Moreover, an AAT may be prescribed to preserve vascular access patency in hemodialysis patients [8,9] or as a primary prevention strategy for high risk patients [10,11].…”

Section: Introductionmentioning

confidence: 99%

Impact of pre-transplant antiaggregant and anticoagulant therapies on early hemorrhagic and cardiovascular events after kidney transplantation

et al. 2015

View full text Add to dashboard Cite

show abstract

Antiplatelet Therapy to Prevent Hemodialysis Vascular Access Failure: Systematic Review and Meta-analysis

Cited by 92 publications

References 26 publications

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Risk of Stroke in Patients with ESRD

Impact of pre-transplant antiaggregant and anticoagulant therapies on early hemorrhagic and cardiovascular events after kidney transplantation

Contact Info

Product

Resources

About