Annals of vascular surgery · 2025
Impact of Antiplatelet and Anticoagulation Therapy on Hemodialysis Reliable Outflow Graft Patency.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Kim Young, Cui Christina L, Eze Anthony Nnaemeka, Chun Tristen T, Kim Charles Y, Dillavou Ellen D, Cox Mitchell W, Southerland Kevin W
Аннотация
BACKGROUND: The Hemodialysis Reliable Outflow (HeRO) graft combines an arteriovenous graft with a central venous stent, allowing for hemodialysis access in patients with end-stage renal disease limited by central venous stenosis. The impact of anticoagulation (AC) and antiplatelet (AP) medications on HeRO graft patency is unknown.
METHODS: Institutional medical records were retrospectively queried for all HeRO graft procedures performed from 2014 to 2023. Data were collected on demographics, medical comorbidities, operative details, and perioperative AC/AP medication use. The Cox proportional hazards model was used to identify risk factors for loss of primary patency.
RESULTS: A total of 232 patients with end-stage renal disease underwent HeRO graft implantation across 3 hospitals, with a median follow-up of 1.5 years. Perioperative AC/AP strategies included mono-antiplatelet therapy (MAPT, n = 38 [16.4%]), dual-antiplatelet therapy (DAPT, n = 57 [24.6%]), AC only (n = 38 [16.4%]), MAPT with AC (n = 66 [28.4%]), DAPT with AC (n = 28 [12.1%]), and none (n = 5 [2.2%]). Direct oral anticoagulants were used in 85 patients (36.6%). There were no differences in bleeding or thrombotic complications between groups (symptomatic hematoma, P = 0.96; pulmonary embolism, P = 0.45). One-year primary patency rates were highest among patients on AP therapy (16.7 ± 6.2% [no AP] vs. 40.2 ± 5.4% [MAPT] vs 33.7 ± 5.6% [DAPT], log-rank P = 0.016). There was no difference with AC use (38.6 ± 5.4% [no AC] vs. 28.8 ± 4.3% [AC], log-rank P = 0.11). After adjusting for patient factors, MAPT (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.35-0.83, P = 0.005) and DAPT (HR 0.64, 95% CI 0.41-1.01, P = 0.05) were protective of loss of primary patency, whereas AC (HR 1.07, 95% CI 0.76-1.50, P = 0.70) did not impact primary patency rates.
CONCLUSION: Among patients undergoing HeRO graft implantation, the use of antiplatelet medications was associated with improved primary patency rates.
METHODS: Institutional medical records were retrospectively queried for all HeRO graft procedures performed from 2014 to 2023. Data were collected on demographics, medical comorbidities, operative details, and perioperative AC/AP medication use. The Cox proportional hazards model was used to identify risk factors for loss of primary patency.
RESULTS: A total of 232 patients with end-stage renal disease underwent HeRO graft implantation across 3 hospitals, with a median follow-up of 1.5 years. Perioperative AC/AP strategies included mono-antiplatelet therapy (MAPT, n = 38 [16.4%]), dual-antiplatelet therapy (DAPT, n = 57 [24.6%]), AC only (n = 38 [16.4%]), MAPT with AC (n = 66 [28.4%]), DAPT with AC (n = 28 [12.1%]), and none (n = 5 [2.2%]). Direct oral anticoagulants were used in 85 patients (36.6%). There were no differences in bleeding or thrombotic complications between groups (symptomatic hematoma, P = 0.96; pulmonary embolism, P = 0.45). One-year primary patency rates were highest among patients on AP therapy (16.7 ± 6.2% [no AP] vs. 40.2 ± 5.4% [MAPT] vs 33.7 ± 5.6% [DAPT], log-rank P = 0.016). There was no difference with AC use (38.6 ± 5.4% [no AC] vs. 28.8 ± 4.3% [AC], log-rank P = 0.11). After adjusting for patient factors, MAPT (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.35-0.83, P = 0.005) and DAPT (HR 0.64, 95% CI 0.41-1.01, P = 0.05) were protective of loss of primary patency, whereas AC (HR 1.07, 95% CI 0.76-1.50, P = 0.70) did not impact primary patency rates.
CONCLUSION: Among patients undergoing HeRO graft implantation, the use of antiplatelet medications was associated with improved primary patency rates.
Предметные рубрики MeSH
HumansVascular PatencyFemaleMaleRenal DialysisRetrospective StudiesPlatelet Aggregation InhibitorsAnticoagulantsAgedGraft Occlusion, VascularRisk FactorsArteriovenous Shunt, SurgicalMiddle AgedTime FactorsTreatment OutcomeBlood Vessel Prosthesis ImplantationKidney Failure, ChronicRisk AssessmentStents