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Published on: March 4, 2016
Single or Dual Antiplatelet Therapy Improves One-Year Arteriovenous Graft Patency and Overall Survival
David P Ebertz1, Saideep Bose2, Armando De Valle2
1Department of General Surgery, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH.
Insights
Single antiplatelet therapy enhances dialysis access survival and patency in AVF and AVG patients. Dual antiplatelet therapy may further improve AVG patency, while anticoagulation appears detrimental.
Area of Science:
- Nephrology
- Vascular Surgery
- Pharmacology
Background:
- Optimal anti-thrombotic therapy post-dialysis access creation lacks consensus.
- Emerging evidence suggests single antiplatelet therapy (SAPT) may improve mortality and patency.
- This study evaluates antiplatelet and anticoagulation effects on dialysis access outcomes.
Purpose of the Study:
- To assess the impact of different antiplatelet and anticoagulation regimens on outcomes after arteriovenous fistula (AVF) and arteriovenous graft (AVG) creation.
- To compare no antiplatelet (No APT), single antiplatelet (SAPT), dual antiplatelet (DAPT), and aspirin with anticoagulation (ASA + AC) cohorts.
- To analyze effects on overall survival, primary patency, and secondary patency.
Main Methods:
- Retrospective analysis of 49,980 AVF and 12,688 AVG patients (2011-2023) from the Vascular Quality Initiative.
- Stratification into four cohorts: No APT, SAPT, DAPT, and ASA + AC.
- Kaplan-Meier and multivariable regression analyses for survival and patency outcomes.
Main Results:
- SAPT improved 1-year primary patency for AVG versus No APT (48% vs. 44%, P=0.03).
- SAPT and DAPT reduced the risk of primary patency loss in AVG patients (HR 0.80, P=0.009 and HR 0.64, P=0.028, respectively).
- Anticoagulation (ASA + AC) was associated with worse survival for both AVF and AVG patients.
Conclusions:
- SAPT improves primary patency for AVF and AVG, and overall survival for AVG.
- DAPT may offer additional patency benefits for AVG.
- Anticoagulation shows no clear benefit and may be associated with higher-risk patients; SAPT or DAPT are recommended post-access creation.
Background:
Following new dialysis access creation there is no consensus on the optimal use of anti-thrombotic therapy. Recent studies have suggested that single antiplatelet therapy may improve hospital mortality as well as patency. The aim of this study was to assess the role of different antiplatelet and anticoagulation therapies on outcomes following dialysis access creation.
Material And Methods:
A retrospective study was conducted utilizing patients from the Vascular Quality Initiative who underwent AV fistula (AVF) and AV graft (AVG) creation from 2011-2023. Patients who were antiplatelet and anticoagulation naive were separated into 4 cohorts: no antiplatelet (No APT), single antiplatelet (SAPT), dual antiplatelet (DAPT), and aspirin with anticoagulation (ASA + AC). Univariate Kaplan-Meier (KM) and multivariable regression analyses were conducted to assess overall survival, primary patency, and secondary patency.
Results:
49,980 patients with AVF creation and 12,688 patients with AVG creation were identified. AVG patients had improved 1-year primary patency with SAPT compared to No APT (48% vs. 44%, P = 0.03) on KM analysis. No difference on KM analysis was observed for AVF. Regression analysis showed decreased risk of loss of primary patency for AVF (HR 0.90, CI 0.83-0.97, P = 0.009). AVG with SAPT showed decreased risk of mortality (HR 0.80, CI 0.64-1.00, P = 0.05) and decreased risk of loss of primary patency (HR 0.80, CI 0.67-0.94, P = 0.009). DAPT also showed decreased risk of loss of primary patency for AVG (HR 0.64, CI 0.43-0.95, P = 0.028). Survival was worse for both AVF and AVG patients on ASA + AC on KM analysis.
Conclusions:
Single antiplatelet therapy following access creation improves primary patency for both AVF and AVG, as well as overall survival for those with AVG. DAPT may further improve primary patency in those with AVG. The use of anticoagulation shows no clear benefit and may be harmful, however is more likely to reflect higher risk patients with other co-morbidities. These results suggest that following an AVF one should consider discharging patients on SAPT, and following an AVG one should consider SAPT or DAPT.
