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Kidney Week

Abstract: PO1334

Use of Ticagrelor to Preserve Hemodialysis Vascular Access

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Hu, Dennis, University of Virginia Health System, Charlottesville, Virginia, United States
  • Lyons, Genevieve R., University of Virginia Health System, Charlottesville, Virginia, United States
  • Ma, Jennie Z., University of Virginia Health System, Charlottesville, Virginia, United States
  • Abdel-Rahman, Emaad M., University of Virginia Health System, Charlottesville, Virginia, United States
Background

Hemodialysis (HD) is the main renal replacement therapy for end stage renal disease (ESRD) patients in the USA. Arteriovenous fistulas (AVF) remain the access of choice due to their superior patency and infection risk when compared to other access forms. The main complications of AVF are stenosis and thrombosis which lead to increased morbidity and hospitalizations in HD patients. There is currently no consensus as to whether thrombo-prophylaxis is warranted. Multiple studies have looked at various antiplatelet agents; however, none have looked at Ticagrelor, a newer antiplatelet that has been shown to inhibit platelet aggregation more effectively than Clopidogrel and is hepatically eliminated.

Methods

We underwent a randomized placebo-controlled single blind pilot study to evaluate the efficacy and safety of Ticagrelor in HD patients with AVF. 33 HD patients aged 18 to 35 years old with AVF were randomized to receive either Ticagrelor 90 mg orally twice a day (n=17) or placebo (n=16) for 6 months. Patients were seen twice a month while on therapy and monthly for 6 months post therapy. The number of vascular interventions and bleeding complications pre-treatment, during treatment, and for 6 months after treatment were recorded to determine efficacy and safety of Ticagrelor, respectively.

Results

No statistically significant difference was noted between Ticagrelor and placebo in terms of number of vascular interventions pre-study, while on therapy, or 6 months post therapy. When adjusting for access vintage, age, and race there was no statistically significant difference between both groups. There was also no statistically significant difference in bleeding complications between both groups.

Conclusion

We conclude that while using Ticagrelor in patients with ESRD on HD is safe, we could not demonstrate a therapeutic superiority in preserving the patency of AVF using this drug compared to placebo. This study is limited by the number of patients and more studies may be warranted in the future.

Outcomes
Endpoint PlaceboTicagrelorp-value (Fisher's exact test)
Intervention month 0-6None14 (87.5%)13 (76.5%)0.66
 1+2 (12.5%)4 (23.5%) 
Intervention month 7-12None13 (81.3%)15 (88.2%)0.66
 1+3 (18.8%)2 (11.8%) 
Bleeding complicationNone13 (81.3%)16 (94.1%)0.34
 1+3 (18.8%)1 (5.9%) 

Funding

  • Commercial Support