Clopidogrel versus acetyl salicylic acid in arteriovenous fistula salvage

Abstract

Background The optimal vascular access for chronic hemodialysis is the arteriovenous fistula (AVF). Several studies suggest a role for antiplatelet agents in the prevention of early AVF failure. Aim of the study This trial was conducted to assess the efficacy and safety of clopidogrel versus acetyl salicylic acid in hemodialysis patients. Patients and Methods A total of 50 patients received 75 mg/day of clopidogrel, 50 patients received 150 mg/day of acetyl salicylic acid, and 50 patients served as the control group. The treatment was initiated 7-10 days before the surgery and continued up to 6 weeks postoperatively; thereafter, patients were monitored for 6 months. Results The primary outcome was AVF failure 8 weeks after fistula creation. The primary AVF failures at 2 months were 32.5% in the acetyl salicylic acid group and 6.6% in the clopidogrel group. First hemodialysis from newly created AVF in the clopidogrel group was significantly more successful than that in the acetyl salicylic acid group. No life-threatening adverse event or severe bleeding was recorded in both groups. Conclusion Clopidogrel seems to be effective and safe compared with acetyl salicylic acid in the prevention of primary AVF failure in hemodialysis patients.