Clopidogrel diminishes hemodialysis access graft thrombosis.
BACKGROUND
The most common complication of hemodialysis (HD) access graft is thrombosis. Clopidogrel, an inhibitor of platelet aggregation, was assessed to prevent this serious complication.


METHODS
A prospective study in which 24 patients on chronic HD whose vascular accesses were grafts were divided into two groups: group A (n = 12, 50%) consisted of patients who did not receive antithrombotic therapy after graft creation, and group B (n = 12, 50%) received clopidogrel 75 mg/day from 2 days after surgery onwards. Both groups were not different according to age, gender, cause of renal failure, hematocrit levels, platelet counts and Kt/V. All patients' thrombotic episodes were followed up from the day of graft surgery until thrombosis was diagnosed. Finally, the patient survival difference between both groups was determined.


RESULTS
Eleven thrombotic episodes were diagnosed in group A while one event was reported in group B (p < 0.001). Graft access days of patency were significantly longer in group B compared to group A (380.8 +/- 170 vs. 90.1 +/- 57.2, p < 0.001). Time that elapsed from dialysis initiation to graft creation was not different (group A 18 +/- 12 days, group B 20 +/- 10 days). Days on HD were different between both groups (group A 208.9 +/- 97.2 vs. group B 583.2 +/- 287.0, p < 0.001) and all patients from group A (n = 12, 100%) and 2 patients from group B (16.7%) died (p = 0.001). Major bleeding events were not reported.


CONCLUSIONS
Clopidogrel significantly decreased thrombotic graft episodes. Patients on clopidogrel had a prolonged vascular access patency, longer time on HD and better survival.
Trimarchi
Hernán
H
Department of Medicine, Hospital Británico, Buenos Aires, Argentina. htrimarchi@hotmail.com
Young
Pablo
P
Forrester
Mariano
M
Schropp
Juan
J
Pereyra
Horacio
H
Freixas
Emilio
E
D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D006435:Renal Dialysis; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D011138:Polytetrafluoroethylene; D000077144:Clopidogrel; D013988:Ticlopidine