Antiplatelet agents for the prevention of arteriovenous fistula and graft thrombosis: a meta analysis

P>Aims: The aim of this study was to evaluate the impact of antiplatelet agents on the thrombosis rates of arteriovenous fistulae and grafts used for haemodialysis access. Methods: In this meta analysis, a systematic search of the literature was used to identify randomised controlled trials evaluating the effect of antiplatelet agents in graft or fistula thrombosis or bleeding. Two authors identified eligible trials and abstracted data on outcomes and study characteristics. The incidence of thrombosis was the primary outcome of interest and was calculated separately for studies evaluating grafts and those evaluating fistulae. A random-effects model was used for statistical pooling. Results: Ten trials were included in the analysis, nine of which reported outcomes on graft or fistula thrombosis. Antiplatelet agents reduced the rate of arteriovenous fistulae thrombosis (OR 0.54, 95% CI 0.31-0.94) but not grafts (OR 0.50, 95% CI 0.16-1.53). Both analyses had a moderate degree of statistical heterogeneity, likely because of differences in study design, antiplatelet agent and dose, as well as other possible factors. Review of bleeding events did not reveal a concerning risk of bleeding, but could not be statistically evaluated. Conclusions: Antiplatelet agents reduce the rate of arteriovenous fistula thrombosis; however, at this time, research does not support the use of these agents for preventing arteriovenous graft thrombosis.