Use of Aspirin Associates with Longer Primary Patency of Hemodialysis Grafts

Dixon, Bradley S.; Beck, Gerald J.; Dember, Laura M.; Vázquez, Miguel A.; Greenberg, Arthur; Delmez, James A.; Allon, Michael; Himmelfarb, Jonathan; Hu, Bo; Greene, Tom; Radeva, Milena; Davidson, Ingemar; İkizler, T. Alp; Braden, Gregory; Lawson, Jeffrey H.; Cotton, James R.; Kusek, John W.; Feldman, Harold I.

doi:10.1681/asn.2010060582

Cited by 44 publications

(28 citation statements)

References 21 publications

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“…Treatment with dipyridamole plus aspirin has a significant but modest effect in reducing the risk of stenosis and improving the duration of primary unassisted patency of newly created grafts [76] . Dixon et al [77] support that use of aspirin is associated with a trend toward longer primary unassisted patency of newly placed HD grafts, similar to that observed for extended-release dipyridamole plus lowdose aspirin (ERDP/ASA). Daily fish oil ingestion did not decrease the proportion of grafts with loss of native patency within 12 mo, although fish oil improved some relevant secondary outcomes, such as graft patency, rates of thrombosis and interventions [78] .…”

Section: Permanent Vamentioning

confidence: 67%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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The number of patients with chronic kidney disease requiring renal replacement therapy has increased worldwide. The most common replacement therapy is hemodialysis (HD). Vascular access (VA) has a key role for successful treatment. Despite the advances that have taken place in the field of the HD procedure, few things have changed with regards to VA in recent years. Arteriovenous fistula (AVF), polytetrafluoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common complications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunction is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the first choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the first choice, followed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most important issue for patients on HD and despite the technical improvements, a number of problems and complications have to be resolved.

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Section: Permanent Vamentioning

confidence: 67%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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“…These patients with hypercoagulable states or combined thrombophilia should be preoperatively identified to tailor antithrombotic therapy and intensify surveillance, especially during the first, most vulnerable months after surgery. However, the optimal prophylaxis for access thrombosis and stenosis is not settled despite extensive efforts (29)(30)(31)(32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Thrombophilia and Arteriovenous Fistula Survival in ESRD

Salmela

Hartman²,

Peltonen³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities.Design, setting, participants, & measurements This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and D-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models.Results Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF.Conclusions Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.

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“…9 Subsequent analysis suggested that aspirin alone might be as effective as dipyridamole plus aspirin. 10 In the study by Lok et al, more than half of all patients were taking aspirin, and more than 10% were taking clopidogrel at baseline. This suggests that fish oil may even be effective in a population of patients receiving aspirin or other antiplatelet agents.…”

Section: Does Time Matter?mentioning

confidence: 99%