• 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, and Giovanni F M Strippoli.
• Department of Medicine, University of Otago, Christchurch, New Zealand.
• Am. J. Kidney Dis. 2013 Jan 1; 61 (1): 112-22.

BackgroundHemodialysis 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 DesignSystematic review and meta-analysis of randomized controlled trials.Setting & PopulationAdults on long-term hemodialysis therapy.Selection CriteriaTrials evaluating hemodialysis vascular access outcomes identified by searches in Cochrane CENTRAL and Renal Group Trial Registers and Embase, without language restriction.InterventionAntiplatelet therapy.OutcomesHemodialysis 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.Results21 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.LimitationsUnclear 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.ConclusionsAntiplatelet 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.Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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