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, 25 (3), 136-42

Oral Prostacycline Analog and Clopidogrel Combination Provides Early Maturation and Long-Term Survival After Arteriovenous Fistula Creation: A Randomized Controlled Study

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Oral Prostacycline Analog and Clopidogrel Combination Provides Early Maturation and Long-Term Survival After Arteriovenous Fistula Creation: A Randomized Controlled Study

A F Abacilar et al. Indian J Nephrol.

Abstract

Vascular access is used as a lifeline for hemodialysis in patients with end stage renal disease failure (ESRD). Failure of arteriovenous fistula (AVF) maturation is still high. The purpose of this study was to research the effects of clopidogrel in combination with oral iloprost, a synthetic analog of prostacyclin PGI2. Ninety-six diabetic ESRD patients were divided into two groups. In the first group (Group 1, N = 50), clopidogrel (75 mg daily dose) and an oral prostacycline analog (200 mg daily dose) were administered. In the second group (Group 2, N = 46), placebo was given. All patients took study medication 7-10 days prior to surgery. A Doppler ultrasound (USG) was performed for measurement of arterial and venous diameters, and peak systolic velocity of arterial flow based on subsequent fistula adequacy. Autogenous AVFs were constructed in forearm as distally as possible in all patients. Both groups were followed-up for a year. In the placebo group, early AVF thrombosis was detected in two patients (4.3%). AVF maturation failure was noted in 14 patients (30.4%) in placebo group and in four patients (8%) in clopidogrel plus oral prostacycline analog group in the early postoperative period (P = 0.001). The mean maturation time was 38 ± 6.5 and 53 ± 12.8 days in study and placebo groups, respectively (P = 0.023). The mean blood flow was 352 ± 94 mL/min in placebo group and 604 ± 125 mL/min in study group (P = 0.001). The arterial end diastolic velocity was 116 ± 14 cm/s in study group and 72 ± 21 cm/s in placebo group (P = 0.036) 1 year after the surgery. Our data indicated that clopidogrel and oral prostacycline analog combination is effective and safe for the prevention of primary AVF failure in hemodialysis patients and decreased acute and chronic thrombotic events.

Keywords: Antiplatelets; arteriovenous fistula; arteriovenous fistula maturation; prostacycline analog; vasodilation.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Doppler ultrasonography (in a gray scale) shows the brachial artery and its diameter in a patient with insulin-dependent diabetes mellitus and peak velocity
Figure 2
Figure 2
Demonstrates the survival rate of arteriovenous fistulas (AVFs) during the study period in group 1 and group 2. Kaplan–Meier estimates of the cumulative incidence of loss of primary AVFs patency in both groups. The median duration of patency was 5.8 months (95% confidence interval (CI): 4.3–7.1) in the group 1 (study group) and 4.3 months (95% CI: 3.6–5.4) in the group 2 (placebo group)
Figure 3
Figure 3
Cumulative incidence for primary end points. This graphic demonstrates the cumulative incidence for the percent of primary end points attributable to flow monitoring compared to total end points in each treatment group. End points due to flow monitoring in the group 1 (study group) and group 2 (placebo-treated control group) are compared to total end points
Figure 4
Figure 4
Demonstrates the comparison of the mean AVFs' flow diagram (left columns) and the differences of arterial end-diastolic velocity (right columns) between the groups. In the early period, we detected high blood flows and lower arterial velocity in study group when we compared groups

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