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Abstract: FR-PO716

Risks and Benefits of Antiplatelet Agents and Anticoagulants on Preventing Vascular Access Dysfunction in Hemodialysis Patients

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Author

  • Wu, Hsin-Hsu, Chang-Gung Memorial Hospital, Taipei, Taiwan
Background

Dialysis adequacy is one major determinant of survival for patients with end-stage renal disease. Good vascular access is essential to achieve adequate dialysis. This study evaluated the impact of different drugs on the vascular access dysfunction rate of an arteriovenous fistula or arteriovenous graft and the rate of major bleeding in hemodialysis patients

Methods

Patients with end-stage renal disease registered in the Taiwan National Health Insurance program from January 1, 1997 to December 31, 2012. A total of 95,992 patients were enrolled in our study. Vascular access dysfunction, defined as the need of thrombectomy or percutaneous angioplasty. Major bleeding, defined as emergent department visits or hospitalization with a primary diagnosis of gastrointestinal bleeding or intracerebral hemorrhage. Adjusted odds ratio between person-quarters with or without antiplatelet or oral anticoagulant using were calculated using logistic regression and inverse probability treatment weighting.

Results

The odds ratio of vascular access dysfunction was 0.17 (0.10-0.28) for aspirin, 0.69 (0.67-0.71) for clopidogrel, 0.62 (0.55-0.71) for dipyridamole, 0.62 (0.50-0.77) for Aggrenox, and 0.86 (0.81-0.90) for warfarin. The highest odds ratio for intracerebral hemorrhage was 2.55 (1.36-4.79) in patients using Aggrenox. The odds ratio for gastrointestinal bleeding was 1.53 (1.28-1.83) for clopidogrel, 1.11 (0.09-13.4) for aspirin, 0.90 (0.38-2.17) for dipyridamole, 1.22 (0.29-5.16) for Aggrenox, and 1.27 (0.79-2.03) for warfarin.

Conclusion

Antiplatelet and anticoagulant agents might reduce vascular access dysfunction rate. The gastrointestinal bleeding rate was increased in clopidogrel using group. Aggrenox might increase the intracerebral hemorrhage rate and should be used with caution.

Funding

  • Clinical Revenue Support