Medical Adjuvant Treatment to Increase Patency of Arteriovenous Fistulae and Grafts - PubMed
, (4), CD002786
Gary Osborn 1 , Xavier Escofet, Anthony Da Silva
1 Department of General Surgery, Singleton Hospital, Swansea NHS Trust, Sketty Lane, Swansea, Wales, UK, SA2 8QA.
PMID: 18843633
DOI: 10.1002/14651858.CD002786.pub2
Gary Osborn et al. Cochrane Database Syst Rev. 2008
Background: End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or an A-V interposition prosthetic shunt for haemodialysis.
Objectives: To determine the effects of adjuvant drug treatment on the patency of fistulae and grafts in patients with ESRD who are undergoing haemodialysis by assessing the number of thrombotic episodes.
Search strategy: The Cochrane Peripheral Vascular Diseases Group (PVD) searched their Specialised Register (last searched May 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2).
Selection criteria: RCTs of active drug versus placebo in patients with ESRD undergoing haemodialysis via an A-V fistula or prosthetic interposition A-V graft.
Data collection and analysis: For the update, two review authors (ADS, GO) independently assessed trial quality and ADS, XE, and GO extracted data. Information on adverse events was collected from the trials. The outcome measure analysed was the long-term fistula or graft patency rate.
Main results: The overall results of the meta-analysis (three RCTs) comparing aspirin versus placebo favoured treatment with aspirin (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.20 to 0.86; P = 0.02).The overall result of the meta-analysis ( three RCTs) comparing ticlopidine (a platelet aggregation inhibitor) versus placebo favoured active treatment (OR 0.47, 95% CI 0.26 to 0.85; P = 0.01).The overall result from one trial comparing the effect of dipyridamole versus placebo and dipyridamole plus aspirin versus placebo favoured treatment (OR 0.57, 95% CI 0.13 to 2.51; OR 0.77, CI 0.19 to 3.19, respectively).One trial compared fish oil (4 g/daily) versus placebo with 24 participants, follow-up 12 months. The overall result favoured treatment (OR 0.07, 95% CI 0.01 to 0.49).One trial compared low-dose warfarin with placebo, 107 patients were followed for 37 months but the trial was terminated prematurely due to increased bleeding events in the treatment group. The overall result favoured placebo (OR 1.76, 95% CI 0.78 to 3.99).One trial compared sulfinpyrazone versus placebo. Sixteen patients, follow-up three months, and the overall result favoured treatment (OR 0.14, 95% CI 0.01 to 1.99).Finally, one trial compared clopidogrel (75 mg/once daily) with placebo. Twenty-four patients, follow-up over a three-year period until their first episode of thrombosis. The overall result favoured treatment (OR 0.01, 95% CI 0.00 to 0.15).
Authors' conclusions: The meta-analysis confirmed the beneficial effect of anti-platelet treatment as an adjuvant used to increase the patency of A-V fistulae and grafts in the short term.
AF Da Silva et al. Cochrane Database Syst Rev (2), CD002786. 2003. PMID 12804437. - Review
The meta-analysis confirmed the beneficial effect of antiplatelet treatment as an adjuvant to increase the patency of A-V fistulae and shunts in the short term.
Medical Adjuvant Treatment to Improve the Patency of Arteriovenous Fistulae and Grafts: A Systematic Review and Meta-analysis
NC Tanner et al. Eur J Vasc Endovasc Surg 52 (2), 243-52. Aug 2016. PMID 27289558. - Review
This systematic review has not demonstrated a beneficial effect for any adjuvant treatment to increase the patency of AVF or grafts in the short term, except ticlopidine …
R Bedenis et al. Cochrane Database Syst Rev (2), CD000535. 2015. PMID 25695213. - Review
Antiplatelet therapy with aspirin or with aspirin plus dipyridamole had a beneficial effect on primary patency of peripheral bypass grafts compared to placebo or no treat …
L Robertson et al. Cochrane Database Syst Rev (8), CD002071. 2012. PMID 22895926. - Review
There is limited evidence suggesting that restenosis/reocclusion at six months following peripheral endovascular treatment is reduced by use of antiplatelet drugs compare …
S Locham et al. J Nephrol 31 (4), 603-611. Aug 2018. PMID 29730781.
In a large national database, we showed that antiplatelet therapy was associated with lower in-hospital mortality. Aspirin and P2Y12-inhibitor use among AVG patients demo …
N Inston et al. Cardiovasc Eng Technol 8 (3), 240-243. Sep 2017. PMID 28721509.
All types of vascular access, a necessity for haemodialysis, are prone to thrombosis and if untreated this results in failure. Thrombosis results from the combination of …
FA Chen et al. PLoS One 11 (11), e0166362. 2016. PMID 27832203.
In our analysis, ACE-I, ARB, and CCB were strongly associated with prolonged primary patency of both AVF and AVG. Further prospective randomized studies are still warrant …
HH Chang et al. Sci Rep 6, 22197. 2016. PMID 26902330.
The protective effects of statins against stenosis for permanent hemodialysis access have been repeatedly demonstrated in animal studies, but remain controversial in huma …
Medical Adjuvant Treatment to Increase Patency of Arteriovenous Fistulae and Grafts - PubMed
, (4), CD002786
Gary Osborn 1 , Xavier Escofet, Anthony Da Silva
1 Department of General Surgery, Singleton Hospital, Swansea NHS Trust, Sketty Lane, Swansea, Wales, UK, SA2 8QA.
PMID: 18843633
DOI: 10.1002/14651858.CD002786.pub2
Gary Osborn et al. Cochrane Database Syst Rev. 2008
Background: End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or an A-V interposition prosthetic shunt for haemodialysis.
Objectives: To determine the effects of adjuvant drug treatment on the patency of fistulae and grafts in patients with ESRD who are undergoing haemodialysis by assessing the number of thrombotic episodes.
Search strategy: The Cochrane Peripheral Vascular Diseases Group (PVD) searched their Specialised Register (last searched May 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2).
Selection criteria: RCTs of active drug versus placebo in patients with ESRD undergoing haemodialysis via an A-V fistula or prosthetic interposition A-V graft.
Data collection and analysis: For the update, two review authors (ADS, GO) independently assessed trial quality and ADS, XE, and GO extracted data. Information on adverse events was collected from the trials. The outcome measure analysed was the long-term fistula or graft patency rate.
Main results: The overall results of the meta-analysis (three RCTs) comparing aspirin versus placebo favoured treatment with aspirin (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.20 to 0.86; P = 0.02).The overall result of the meta-analysis ( three RCTs) comparing ticlopidine (a platelet aggregation inhibitor) versus placebo favoured active treatment (OR 0.47, 95% CI 0.26 to 0.85; P = 0.01).The overall result from one trial comparing the effect of dipyridamole versus placebo and dipyridamole plus aspirin versus placebo favoured treatment (OR 0.57, 95% CI 0.13 to 2.51; OR 0.77, CI 0.19 to 3.19, respectively).One trial compared fish oil (4 g/daily) versus placebo with 24 participants, follow-up 12 months. The overall result favoured treatment (OR 0.07, 95% CI 0.01 to 0.49).One trial compared low-dose warfarin with placebo, 107 patients were followed for 37 months but the trial was terminated prematurely due to increased bleeding events in the treatment group. The overall result favoured placebo (OR 1.76, 95% CI 0.78 to 3.99).One trial compared sulfinpyrazone versus placebo. Sixteen patients, follow-up three months, and the overall result 
favoured treatment (OR 0.14, 95% CI 0.01 to 1.99).Finally, one trial compared clopidogrel (75 mg/once daily) with placebo. Twenty-four patients, follow-up over a three-year period until their first episode of thrombosis. The overall result favoured treatment (OR 0.01, 95% CI 0.00 to 0.15).
Authors' conclusions: The meta-analysis confirmed the beneficial effect of anti-platelet treatment as an adjuvant used to increase the patency of A-V fistulae and grafts in the short term.
AF Da Silva et al. Cochrane Database Syst Rev (2), CD002786. 2003. PMID 12804437. - Review
The meta-analysis confirmed the beneficial effect of antiplatelet treatment as an adjuvant to increase the patency of A-V fistulae and shunts in the short term.
Medical Adjuvant Treatment to Improve the Patency of Arteriovenous Fistulae and Grafts: A Systematic Review and Meta-analysis
NC Tanner et al. Eur J Vasc Endovasc Surg 52 (2), 243-52. Aug 2016. PMID 27289558. - Review
This systematic review has not demonstrated a beneficial effect for any adjuvant treatment to increase the patency of AVF or grafts in the short term, except ticlopidine …
R Bedenis et al. Cochrane Database Syst Rev (2), CD000535. 2015. PMID 25695213. - Review
Antiplatelet therapy with aspirin or with aspirin plus dipyridamole had a beneficial effect on primary patency of peripheral bypass grafts compared to placebo or no treat …
L Robertson et al. Cochrane Database Syst Rev (8), CD002071. 2012. PMID 22895926. - Review
There is limited evidence suggesting that restenosis/reocclusion at six months following peripheral endovascular treatment is reduced by use of antiplatelet drugs compare …
S Locham et al. J Nephrol 31 (4), 603-611. Aug 2018. PMID 29730781.
In a large national database, we showed that antiplatelet therapy was associated with lower in-hospital mortality. Aspirin and P2Y12-inhibitor use among AVG patients demo …
N Inston et al. Cardiovasc Eng Technol 8 (3), 240-243. Sep 2017. PMID 28721509.
All types of vascular access, a necessity for haemodialysis, are prone to thrombosis and if untreated this results in failure. Thrombosis results from the combination of …
FA Chen et al. PLoS One 11 (11), e0166362. 2016. PMID 27832203.
In our analysis, ACE-I, ARB, and CCB were strongly associated with prolonged primary patency of both AVF and AVG. Further prospective randomized studies are still warrant …
HH Chang et al. Sci Rep 6, 22197. 2016. PMID 26902330.
The protective effects of statins against stenosis for permanent hemodialysis access have been repeatedly demonstrated in animal studies, but remain controversial in huma …