The Impact Of Antithrombotic Medications And Patient Factors On Hemodialysis Reliable Outflow Graft Performance
Samantha Terranella, M.D., Oyedolamu Olaitan, MD, Edward Hollinger, Edie Chan, MD.
Rush University, Chicago, IL, USA.
OBJECTIVES: Hemodialysis Reliable Outflow (HeRO) grafts are an alternative to central venous catheters for dialysis use in patients with end-stage renal disease. This study aimed to assess the impact of patient comorbid conditions and antithrombotic medication use on HeRO graft outcomes. METHODS: A single-center, retrospective analysis was conducted on all patients who underwent HeRO graft placement between October 2009 and January 2019. We assessed the impact of patient demographics, comorbidities and antithrombotic medication use on overall graft patency and number of interventions to restore or maintain patency.RESULTS: Sixty-seven patients underwent HeRO graft placement with a median patency length of 2 years and the longest patency length of 8.5 years. Primary patency at 1 year was 11.9%. Secondary patency at 1 year was 68.0% with a median number of endovascular and operative interventions of 4 and 1. Different type and combination of medications did not impact the duration of graft survival, but did impact the number of required interventions to restore patency. Patients who were on anticoagulation combined with a P2Y12 inhibitor compared to anticoagulation alone were less likely to require endovascular intervention (IRR:0.24, 95% CI=0.05-1.00). Aspirin use was also associated with decreased endovascular intervention rates compared to both aspirin in combination with anticoagulation use, aspirin in combination with a P2Y12 inhibitor, or anticoagulation use alone (IRR: 0.45, 95% CI=0.21-0.96; IRR: 0.40, 95% CI=0.18-0.86; IRR: 0.35, 95% C =0.13-0.97). Patients who were on aspirin were less likely to require operative interventions compared with those who took anticoagulation alone (IRR: 0.21, 95% CI=0.05-0.89). Aspirin use alone compared to aspirin and P2Y12 inhibitor, or a P2Y12 inhibitor and anticoagulation was found to also be associated with reduced risk of operative re-intervention (IRR:0.20, 95% CI=0.05-0.76 and IRR:0.18, 95% CI=0.05-0.76). Hypercoagulable disorders, obesity, peripheral vascular disease, hypertension, and hyperlipidemia were associated with increased risk of HeRO graft dysfunction or failure.CONCLUSIONS: The presence of hypercoagulability, obesity, peripheral vascular disease, hypertensive, and hyperlipidemia are associated with worse outcomes overall outcomes in HeRO grafts. The use of antiplatelet and anticoagulation medication was highly variable and not shown to be clearly associated with overall HeRO graft survival, but did impact the number of interventions required to restore graft patency. The findings from this study may inform antithrombotic medication prescribing in patients with HeRO grafts.
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