Essentials Uncertainty remains about antiplatelets for vascular access patency in
hemodialysis patients. 95 971 people under
hemodialysis were followed in a claims database in Taiwan.
Aspirin reduced vascular access failure rate and did not increase major
bleeding rate.
Clopidogrel,
Aggrenox, and
warfarin might increase major
bleeding rate. SUMMARY: Background Dialysis adequacy is a major determinant of survival for patients with
end-stage renal disease. Good vascular access is essential to achieve adequate dialysis. Objectives This study evaluated the impacts of different drugs on the vascular access failure rate of an
arteriovenous fistula or an arteriovenous graft and the rate of major
bleeding in
hemodialysis patients. Patients and methods We studied patients with
end-stage renal disease registered in the Taiwan National Health Insurance program from 1 January 1997 to 31 December 2012. A total of 95 971 patients were enrolled in our study. Vascular access dysfunction was defined as the need for
thrombectomy or percutaneous angioplasty. Major
bleeding was defined as emergency department visits or hospitalization with a primary diagnosis of gastrointestinal
bleeding or
intracerebral hemorrhage. The adjusted odds ratios between person-quarters with or without antiplatelet or oral
anticoagulant use were calculated using a generalized estimating equation. Results The odds ratio of vascular access failure was 0.21 (0.11-0.39) for
aspirin, 0.76 (0.74-0.79) for
clopidogrel, 0.67 (0.59-0.77) for
dipyridamole, 0.67 (0.53-0.86) for
Aggrenox and 0.96 (0.90-1.03) for
warfarin. The highest odds ratio for
intracerebral hemorrhage was 5.33 (1.25-22.72) in younger patients using
Aggrenox. The highest odds ratio for gastrointestinal
bleeding was 1.34 (1.10-1.64) for
clopidogrel. Conclusion
Antiplatelet agents, but not
warfarin, might reduce the vascular access
thrombosis rate. The gastrointestinal
bleeding rate was increased in the group using
clopidogrel.
Aggrenox should be used with caution in young individuals because it might increase the rate of
intracerebral hemorrhage.