Medical Adjunctive Therapy to Increase Arteriovenous Fistula and Graft Patency
Mohamed I, Kamarizan MF, Da SilvaA. Medical adjuvant therapy to enhance patency of arteriovenous fistulas and grafts. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD002786. doi: 10.1002 /14651858.CD002786.pub4. Accessed July 28, 2021.
Commentary
This study was conducted to evaluate the effect of adjunctive drug therapy in patients with ESRD on hemodialysis via autologous AVF or prosthetic interventional AVG.
The main findings were that a total of 13 trials with 2080 participants were reviewed, and the certainty of evidence was low to moderate due to short follow-up periods, heterogeneity between trials, small sample sizes, and risk of bias due to incomplete reporting.
The medical adjunctive therapies used in the included trials were.
Aspirin
Ticlopidine
Dipyridamole
Dipyridamole and aspirin
Warfarin
Fish oil
Clopidogrel
Sulfinpyrazone.
Glyceryl trinitrate (GTN) patch
All included studies reported on graft patency by measuring graft thrombosis, and there was insufficient evidence to determine whether there was a difference in graft patency in studies comparing aspirin to placebo.
A meta-analysis of graft patency comparing ticlopidine to placebo favored ticlopidine.
There is now insufficient evidence to determine whether there is a difference in graft patency in studies comparing fish oil to placebo, and the same is true for studies comparing clopidogrel to placebo.
There was insufficient evidence to determine whether there was a difference in graft patency between the effects of dipyridamole and placebo and the effects of dipyridamole and aspirin.
Only two studies published data on secondary outcomes of relevant interventions (surgical or radiological). They said there was insufficient evidence to determine if there was a difference in the relevant intervention between the placebo and treatment groups.
None of the included studies reported on length of hospital stay and reported on complications ranging from mortality to nausea.
However, data on complications were limited, and reporting varied between studies.
The authors concluded that
A meta-analysis of three studies on ticlopidine (antiplatelet therapy), all of which used the same dose of therapy, but with a short follow-up of only one month, suggests that ticlopidine may have a beneficial effect as an adjunctive therapy to increase patency.
In the short term, there was insufficient evidence to determine if there was a difference in graft patency between AVF and AVG placebo and other treatments such as aspirin, fish oil, clopidogrel, dipyridamole, dipyridamole and aspirin, warfarin, sulfinpyrazone, and GTN patches.
The certainty of the evidence was low to moderate due to the short follow-up period, small number of studies for each comparison, small sample size, heterogeneity among studies, and risk of bias due to incomplete reporting.
