Clopidogrel decreases arteriovenous fistula thrombosis but does not improve fistula maturation.
This Practice Point commentary discusses Dember et al.'s randomized, double-blind, placebo-controlled trial of clopidogrel treatment after the creation of an arteriovenous fistula for dialysis. In total, 877 patients were treated with either placebo or clopidogrel (300 mg loading dose followed by 75 mg daily) for 6 weeks after fistula creation. Treatment with clopidogrel was associated with a significantly lower rate of fistula thrombosis than was placebo (12.2% vs 19.5%; P = 0.018). This reduction did not, however, lead to any changes in the secondary end point of attaining a useable access for dialysis; therefore, routine treatment with clopidogrel after fistula creation was not of clinical benefit in this well-conducted trial.
Gersch
Michael S
MS
Hot Springs Diagnostic Associates, Hot Springs, AR 71901, USA. michael_gersch@yahoo.com