title: Safety of percutaneous tunneled hemodialysis catheter procedures in patients receiving concurrent clopidogrel therapy.
abstract: OBJECTIVE
  Patients on clopidogrel are at increased risk of bleeding. This study was commenced to assess the incidence of bleeding in dialysis patients who underwent tunneled hemodialysis catheter procedures while on clopidogrel therapy.
  
  
  METHODS
  This is a single center retrospective study of 25 (10 men, 15 women; median age 70) dialysis patients in whom clopidogrel could not be discontinued and underwent tunneled hemodialysis catheter insertion, removal or exchange between the period March 2010 to November 2011. The medical records of patients were reviewed and complications were classified according to the Society of Interventional Radiology system. Fifty-three procedures (22 insertions, 11 exchanges and 20 removals) were performed in these patients. The pre-procedural median platelet count, International Normalized Ratio and partial thromboplastin time were 195×103/dL (range 50-666), 1.1 (range 0.9-3.3) and 26.3 seconds (range 22.5-69.8) respectively.
  
  
  CONCLUSIONS
  Forty-six procedures were performed in patients on clopidogrel and aspirin treatment. Five procedures were performed in patients while on clopidogrel in combination with aspirin and warfarin, and two procedures were performed with patients on clopidogrel alone. There were no documented bleeding complications from tunneled hemodialysis catheter procedures performed in patients on concurrent clopidogrel therapy in our study. Further prospective assessment with a larger cohort is necessary in order to validate these findings.
authors.affiliation: Departments of Vascular Imaging and Intervention, Nephrology, Medicine and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston - USA.
authors.forename: Gloria Maria
authors.initials: GM
authors.lastname: Martinez Salazar
authors.forename: Chieh Suai
authors.initials: CS
authors.lastname: Tan
authors.forename: Kenneth
authors.initials: K
authors.lastname: Spearman
authors.forename: Stephen
authors.initials: S
authors.lastname: Wicky
authors.forename: Steven
authors.initials: S
authors.lastname: Wu
mesh_terms: D000368:Aged; D001900:Boston; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects; D000077144:Clopidogrel; D020878:Device Removal; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine