Should patients be on antithrombotic medication for their first arteriovenous fistulae?

Evidence on the effect of antithrombotic medication on reducing early and late fistula failure is inconclusive. Antithrombotic use carries risks in patients with end-stage renal failure and could increase the risk of needling complications as a result of bleeding. The objectives of this study are to determine the effect of antithrombotic agents on early and late fistula failure and on the risk of interrupted start of cannulation of the fistula.

Retrospective analysis of two prospectively maintained databases of access operations and dialysis sessions of 671 patients who had their first fistula between 2004 and 2011. Early failure was defined as failure to reach six consecutive dialysis sessions at any time with two needles on the index form of access. Fistula survival was defined as the time from when the fistula was first used to fistula abandonment.

Primary failure was similar between patients on antiplatelet (18.8%), anticoagulants (18.4%) or no antithrombotic medication (18.8%; p = 0.998). Antithrombotic medication did not have an effect on AVF survival (p = 0.86). Antithrombotic medication did not increase complicated cannulation rates, defined as the percentage of patients failing to achieve six uninterrupted dialysis sessions from the start (p = 0.929).

Antithrombotic medication had no significant effect on primary failure rate, long-term fistula survival or initial complicated cannulation rates in our study. This suggests that patients already on antithrombotic medication can continue taking them without increasing the risk of interrupted dialysis.