Antiplatelets and native arteriovenous fistula dysfunction

Area of Science:

• Nephrology
• Vascular Surgery
• Pharmacology

Background:

• Native arteriovenous fistula (AVF) dysfunction is a significant complication.
• Preventing AVF dysfunction is crucial for effective hemodialysis access.
• Antiplatelet therapy is a potential strategy to maintain AVF patency.

Purpose of the Study:

• To systematically review the safety and efficacy of antiplatelet therapy in preventing native AVF dysfunction.
• To evaluate the impact of antiplatelet agents on primary AVF patency and secondary outcomes.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) adhering to PRISMA 2020 guidelines.
• Inclusion of RCTs assessing antiplatelet therapy post-native AVF creation.
• Primary endpoint: AVF primary patency; Secondary endpoints: maturation, abandonment, bleeding.

Main Results:

• Twelve RCTs (2,491 patients) analyzed antiplatelet drugs including aspirin, clopidogrel, ticlopidine, and dipyridamole.
• Postoperative antiplatelet use improved AVF primary patency (OR 2.28).
• Ticlopidine 250mg twice daily showed significant patency improvement (OR 3.48); other agents had varied effects. No significant differences in maturation, abandonment, or bleeding were noted.

Conclusions:

• Antiplatelet therapy is safe and effective in preserving native AVF patency.
• Ticlopidine and clopidogogrel appear to be key contributors to improved AVF patency.
• Adenosine diphosphate (ADP) receptor antagonists show promise for maintaining AVF patency.