Journal of Nephrology

, Volume 31, Issue 4, pp 603–611 | Cite as

Role of antiplatelet therapy in the durability of hemodialysis access

  • Satinderjit Locham
  • Robert J. Beaulieu
  • Hanaa Dakour-Aridi
  • Besma Nejim
  • Mahmoud B. MalasEmail author
Original Article



Antiplatelet therapy (APT) is often used on anecdotal grounds to improve vascular access patency. The aim of this study was to assess the role of APT in hemodialysis (HD) patients undergoing arteriovenous fistula (AVF) or graft (AVG) placement.


All patients in a large HD vascular qualitative initiative database (2011–2017) were included and divided into no antiplatelet therapy (no-APT) vs. any APT [aspirin (ASA) or P2Y12 inhibitors (PI)]. Multivariate [logistic (MLR) and Cox (MCR) regression] analyses were used as appropriate.


A total of 24,847 patients undergoing HD access creation were identified (78% AVF). APT was noted among 49 and 46% of AVG and AVF patients, respectively. In MLR analysis, patients on no-APT vs. APT had a 12-fold increased risk of in-hospital mortality (odds ratio (OR) 11.79, [95% confidence interval 5.30–26.26]) and the risk of developing steal syndrome was higher among patients discharged on APT (OR 1.81, [1.19–2.76]). In patients undergoing AVF, primary patency (PP) was similar between APT and no-APT. However, in patients undergoing AVG, PP rates at 12 months were significantly higher for APT: ASA (47 vs. 41%) and PI (51 vs. 41%) than for no-APT (p = 0.008). At MCR analysis, the loss of PP at 12 months was 13% lower in ASA users (hazard ratio (HR) 0.87, [0.77–0.97], p = 0.02) and 24% lower in PI users (HR 0.76, [0.57–0.99], p = 0.046) compared to no-APT.


In a large national database, we showed that antiplatelet therapy was associated with lower in-hospital mortality. Aspirin and P2Y12-inhibitor use among AVG patients demonstrated improved PP rates compared to no antiplatelet therapy. We recommend the use of antiplatelet therapy especially in patients on AVG.


AVF AVG Aspirin Clopidogrel 



No special funding was obtained to complete this study.

Compliance with ethical standards:

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

VQI database contains de-identified data, the need for patient informed consent was waived and institution review board (IRB) approval was exempted by the IRB.

Supplementary material

40620_2018_490_MOESM1_ESM.docx (118 kb)
Supplementary material 1 (DOCX 117 KB)


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Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  • Satinderjit Locham
    • 1
  • Robert J. Beaulieu
    • 3
  • Hanaa Dakour-Aridi
    • 1
  • Besma Nejim
    • 1
  • Mahmoud B. Malas
    • 1
    • 2
    • 3
    Email author
  1. 1.Johns Hopkins Bayview Vascular and Endovascular Clinical Research CenterBaltimoreUSA
  2. 2.Center for Research Excellence and Clinical TrialsJohns Hopkins HospitalBaltimoreUSA
  3. 3.Johns Hopkins Medical InstitutionsBaltimoreUSA

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