Antiplatelet therapy to prevent hemodialysis vascular access failure: Systematic review and meta-analysis

Suetonia C. Palmer, Lucia Di Micco, Mona Razavian, Jonathan C. Craig, Pietro Ravani, Vlado Perkovic, Gianni Tognoni, Giusi Graziano, Meg Jardine, Fabio Pellegrini, Antonio Nicolucci, Angela Webster, Giovanni F M Strippoli

Research output: Contribution to journalArticle

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. Study Design: Systematic review and meta-analysis of randomized controlled trials. Setting & Population: Adults on long-term hemodialysis therapy. Selection Criteria: Trials evaluating hemodialysis vascular access outcomes identified by searches in Cochrane CENTRAL and Renal Group Trial Registers and Embase, without language restriction. Intervention: Antiplatelet therapy. Outcomes: 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. Limitations: 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.

Original languageEnglish
Pages (from-to)112-122
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume61
Issue number1
DOIs
Publication statusPublished - Jan 2013

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Keywords

  • antiplatelet agent
  • Dialysis
  • meta-analysis
  • systematic reviews
  • thrombosis
  • vascular access

ASJC Scopus subject areas

  • Nephrology

Cite this

Palmer, S. C., Di Micco, L., Razavian, M., Craig, J. C., Ravani, P., Perkovic, V., Tognoni, G., Graziano, G., Jardine, M., Pellegrini, F., Nicolucci, A., Webster, A., & Strippoli, G. F. M. (2013). Antiplatelet therapy to prevent hemodialysis vascular access failure: Systematic review and meta-analysis. American Journal of Kidney Diseases, 61(1), 112-122. https://doi.org/10.1053/j.ajkd.2012.08.031