title: Antiplatelet therapy to prevent hemodialysis vascular access failure: systematic review and meta-analysis.
abstract: BACKGROUND
  Hemodialysis vascular access failure occurs often and increases morbidity for people on hemodialysis therapy. Antiplatelet agents may prevent hemodialysis vascular access failure, but potentially may be hazardous in people with end-stage kidney disease who have impaired hemostasis.
  
  
  METHODS
  Systematic review and meta-analysis of randomized controlled trials.
  
  
  METHODS
  Adults on long-term hemodialysis therapy.
  
  
  METHODS
  Trials evaluating hemodialysis vascular access outcomes identified by searches in Cochrane CENTRAL and Renal Group Trial Registers and Embase, without language restriction.
  
  
  METHODS
  Antiplatelet therapy.
  
  
  RESULTS
  Hemodialysis vascular access failure (thrombosis or loss of patency), failure to attain vascular access suitable for dialysis, need for intervention to attain patency or assist maturation, major bleeding, minor bleeding, and antiplatelet treatment withdrawal. Treatment effects were summarized as RRs with 95% CIs using random-effects meta-analysis.
  
  
  RESULTS
  21 eligible trials (4,826 participants) comparing antiplatelet treatment with placebo or no treatment were included. 12 trials (3,118 participants) started antiplatelet therapy around the time of dialysis vascular access surgery and continued treatment for approximately 6 months. Antiplatelet treatment reduced fistula failure (thrombosis or loss of patency) by one-half (6 trials, 1,222 participants; RR, 0.49; 95% CI, 0.30-0.81) but had uncertain effects on graft patency and attaining fistula or graft function suitable for dialysis. Overall, antiplatelet treatment had uncertain effects on major bleeding.
  
  
  CONCLUSIONS
  Unclear or high risk of bias in most trials and few trial data, particularly for antiplatelet effects on graft function and vascular access suitability for dialysis.
  
  
  CONCLUSIONS
  Antiplatelet treatment protects fistula from thrombosis or loss of patency, but has little or no effect on graft patency and uncertain effects on vascular access maturation for dialysis and major bleeding. Interventions that demonstrably improve vascular access suitability for dialysis are needed.
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Micco
authors.forename: Mona
authors.initials: M
authors.lastname: Razavian
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Giusi
authors.initials: G
authors.lastname: Graziano
authors.forename: Meg
authors.initials: M
authors.lastname: Jardine
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Angela
authors.initials: A
authors.lastname: Webster
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D062666:Vascular Access Devices / Q000009:adverse effects; D014654:Vascular Patency / Q000187:drug effects
chemical_list: D010975:Platelet Aggregation Inhibitors