Background: The most common complication of hemodialysis access graft is thrombosis. Clopidogrel, an inhibitor of platelet aggregation, was assessed to prevent this serious complication.
Methods: Nineteen patients on chronic hemodialysis whose vascular accesses were grafts were divided into two groups: Group A (n=11, 58%) consisted of patients who did not receive anti-thrombotic therapy after graft placement; Group B (n=8, 42%) received clopidogrel 75 mg/day from two days after surgery onwards. Both groups were well matched with respect to age, gender, cause of renal failure, hematocrit, platelet count and Kt/V. All patients' thrombotic episodes were followed up from the day of graft surgery until thrombosis was diagnosed. Finally, the survival difference between both groups was determined.
Results: Ten thrombotic episodes were diagnosed in Group A while no events were reported in Group B (p<0.001). Graft access days of patency were significantly more in Group B than in Group A (350.8+/-166 vs 86.8+/-69, p<0.001). The time elapsed from dialysis initiation to graft placement was not different (Group A: 18+/-12 days; Group B: 20+/-10 days). Days in hemodialysis were different between both groups (Group A: 195.9+/-96; Group B: 545.5+/-291, p<0.001) and all patients of Group A (n=11, 57.9%) and two patients of Group B (25%) died (p=0.001). No major bleeding events were reported.
Conclusions: Clopidogrel significantly decreased thrombotic graft episodes. Patients on clopidogrel had a prolonged vascular access patency, longer time on hemodialysis and longer survival.