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


METHODS
Nineteen patients on chronic hemodialysis whose vascular accesses were grafts were divided into two groups: Group A (n=11, 58%) consisted of patients who did not receive anti-thrombotic therapy after graft placement; Group B (n=8, 42%) received clopidogrel 75 mg/day from two days after surgery onwards. Both groups were well matched with respect to age, gender, cause of renal failure, hematocrit, platelet count and Kt/V. All patients' thrombotic episodes were followed up from the day of graft surgery until thrombosis was diagnosed. Finally, the survival difference between both groups was determined.


RESULTS
Ten thrombotic episodes were diagnosed in Group A while no events were reported in Group B (p<0.001). Graft access days of patency were significantly more in Group B than in Group A (350.8+/-166 vs 86.8+/-69, p<0.001). The time elapsed from dialysis initiation to graft placement was not different (Group A: 18+/-12 days; Group B: 20+/-10 days). Days in hemodialysis were different between both groups (Group A: 195.9+/-96; Group B: 545.5+/-291, p<0.001) and all patients of Group A (n=11, 57.9%) and two patients of Group B (25%) died (p=0.001). No major bleeding events were reported.


CONCLUSIONS
Clopidogrel significantly decreased thrombotic graft episodes. Patients on clopidogrel had a prolonged vascular access patency, longer time on hemodialysis and longer survival.
Nephrology Section, Department of Medicine, Hospital Británico de Buenos Aires, Argentina. htrimarchi@hotmail.com
H
H
Trimarchi
P
P
Young
M
M
Forrester
J
J
Schropp
H
H
Pereyra
E
E
Freixas