Combined aspirin and sulfinpyrazone in the prevention of recurrent hemodialysis vascular access thrombosis.
We carried out a pilot study in 15 hemodialysis patients with recurrent vascular access thrombosis to examine whether the combination of low dose aspirin (85 mg once daily) and sulfinpyrazone (200 mg three times daily) is safe and effective in the prevention of vascular access thrombosis. Hemostatic measurements were performed prior to and after four weeks of starting the drug combination. Baseline values for fibrinopeptide A were elevated in all patients while those for platelet factor 4, fibrinogen, antithrombin III and protein C were generally within normal limits. A major reduction in the frequency of vascular access thrombosis from 0.114 per month to 0.04 per month was noted during combined drug treatment (p less than 0.001). Although in vitro platelet aggregation to various stimuli was markedly suppressed and platelet thromboxane B2 formation was almost completely inhibited in patients on aspirin/sulfinpyrazone, this was not associated with a significant further prolongation of the bleeding time. A relatively high rate of complications, particularly mild gastrointestinal bleeding, was noted in patients on aspirin/sulfinpyrazone that could not be predicted on the basis of pre-treatment hemostatic test results.
Domoto
D T
DT
Division of Nephrology, St. Louis University School of Medicine, Missouri 63110.
Bauman
J E
JE
Joist
J H
JH
D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D002408:Catheters, Indwelling; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D010865:Pilot Projects; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D012008:Recurrence; D006435:Renal Dialysis; D013442:Sulfinpyrazone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013927:Thrombosis / Q000503:physiopathology / Q000517:prevention & control*; D013929:Thromboxane B2 / Q000096:biosynthesis
D010975:Platelet Aggregation Inhibitors; D013929:Thromboxane B2; D001241:Aspirin; D013442:Sulfinpyrazone