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Antiplatelet And Anticoagulant Impact On Patients With Lower Extremity Arteriovenous Dialysis Access
Gavin Christy, B.S.
1, David Ebertz, M.D.
1, Jeffrey Siracuse, M.D.
2, Matthew R. Smeds, M.D.
1.
1St. Louis University School of Medicine, St. Louis, MO, USA, 2Chobanian and Avedisian School of Medicine, Boston, MA, USA.
OBJECTIVES: Lower extremity access remains a last resort for many patients needing dialysis. The role antiplatelets or anticoagulants (AC) play on their patency is unknown. We sought to identify the effects of antiplatelet or AC therapy prescribed at discharge on patency and survival in patients undergoing creation of lower extremity dialysis access.
METHODS: All patients in the Vascular Quality Initiative dialysis module with a lower extremity AV fistula (AVF) or AV graft (AVG) created from 2011-2023 were retrospectively analyzed. Medications prescribed at discharge were organized into single antiplatelet (SAPT), dual antiplatelet (DAPT), and SAPT+AC. SAPT was divided into aspirin and clopidogrel. Univariable Kaplan-Meijer (KM) and multivariable regression analyses were utilized to assess impact of discharge medication on survival and primary/secondary patency.
RESULTS: 1,214 patients underwent lower extremity dialysis access creation with 151 (12.4%) being AVFs and 1,063 (87.6%) being AVGs. Of AVF patients, 41 were discharged on no medication (27.2%), 56 (37.1%) on SAPT (51 (91.1%) aspirin and 5 (8.9%) clopidogrel), 9 (6.0%) on DAPT, and 12 (8.0%) on SAPT+AC. Following AVG creation, 349 (28.7%) of patients were discharged on no medications, 331 (27.3%) on SAPT (272 (82.2%) aspirin and 59 (17.8%) clopidogrel), 79 (6.5%) on DAPT, and 97 (8.0%) on SAPT+AC. KM and multivariable analyses showed no difference in survival, primary patency, or secondary patency based on medication following AVF creation. Following AVG creation, there was no difference in survival or primary patency. KM analysis of AVG suggested better secondary patency at one year with SAPT (No APT 72.4%; SAPT 80.7%; DAPT 65.2%; SAPT+AC 69.1%, p > 0.05) (Figure 1). Multivariable analysis showed decreased risk of losing secondary patency with SAPT (HR 0.20, CI 0.06-0.69, p = 0.01). Further, this decreased risk was observed with clopidogrel (HR 0.04, CI 0.00-0.74, p = 0.03) but not for patients on aspirin (HR 0.30, CI 0.08-1.10, p = 0.07).
CONCLUSIONS: This analysis suggests SAPT is protective for lower extremity AVG with clopidogrel showing statistically significant protection. This suggests that SAPT is a viable option for prolonging AVG patency. Further study on antiplatelet usage following lower extremity dialysis access creation is warranted.
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