Osborn Gary, Escofet Xavier, Da Silva Anthony
Department of General Surgery, Singleton Hospital, Swansea NHS Trust, Sketty Lane, Swansea, Wales, UK, SA2 8QA.
Cochrane Database Syst Rev. 2008 Oct 8(4):CD002786. doi: 10.1002/14651858.CD002786.pub2.
End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or an A-V interposition prosthetic shunt for haemodialysis.
To determine the effects of adjuvant drug treatment on the patency of fistulae and grafts in patients with ESRD who are undergoing haemodialysis by assessing the number of thrombotic episodes.
The Cochrane Peripheral Vascular Diseases Group (PVD) searched their Specialised Register (last searched May 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2).
RCTs of active drug versus placebo in patients with ESRD undergoing haemodialysis via an A-V fistula or prosthetic interposition A-V graft.
For the update, two review authors (ADS, GO) independently assessed trial quality and ADS, XE, and GO extracted data. Information on adverse events was collected from the trials. The outcome measure analysed was the long-term fistula or graft patency rate.
The overall results of the meta-analysis (three RCTs) comparing aspirin versus placebo favoured treatment with aspirin (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.20 to 0.86; P = 0.02).The overall result of the meta-analysis ( three RCTs) comparing ticlopidine (a platelet aggregation inhibitor) versus placebo favoured active treatment (OR 0.47, 95% CI 0.26 to 0.85; P = 0.01).The overall result from one trial comparing the effect of dipyridamole versus placebo and dipyridamole plus aspirin versus placebo favoured treatment (OR 0.57, 95% CI 0.13 to 2.51; OR 0.77, CI 0.19 to 3.19, respectively).One trial compared fish oil (4 g/daily) versus placebo with 24 participants, follow-up 12 months. The overall result favoured treatment (OR 0.07, 95% CI 0.01 to 0.49).One trial compared low-dose warfarin with placebo, 107 patients were followed for 37 months but the trial was terminated prematurely due to increased bleeding events in the treatment group. The overall result favoured placebo (OR 1.76, 95% CI 0.78 to 3.99).One trial compared sulfinpyrazone versus placebo. Sixteen patients, follow-up three months, and the overall result favoured treatment (OR 0.14, 95% CI 0.01 to 1.99).Finally, one trial compared clopidogrel (75 mg/once daily) with placebo. Twenty-four patients, follow-up over a three-year period until their first episode of thrombosis. The overall result favoured treatment (OR 0.01, 95% CI 0.00 to 0.15).
AUTHORS' CONCLUSIONS: The meta-analysis confirmed the beneficial effect of anti-platelet treatment as an adjuvant used to increase the patency of A-V fistulae and grafts in the short term.
终末期肾病（ESRD）患者通常需要建立动静脉（A-V）内瘘或植入A-V人工血管分流来进行血液透析。
通过评估血栓形成事件的数量，确定辅助药物治疗对接受血液透析的ESRD患者内瘘和人工血管通畅性的影响。
Cochrane外周血管疾病组（PVD）检索了其专业注册库（最近一次检索时间为2008年5月）以及Cochrane对照试验中央注册库（CENTRAL）（《Cochrane图书馆》2008年第2期）。
对通过A-V内瘘或人工血管植入进行血液透析的ESRD患者，比较活性药物与安慰剂的随机对照试验（RCT）。
在本次更新中，两位综述作者（ADS、GO）独立评估试验质量，ADS、XE和GO提取数据。从试验中收集不良事件信息。分析的结局指标是长期内瘘或人工血管通畅率。
比较阿司匹林与安慰剂的荟萃分析（三项RCT）的总体结果支持阿司匹林治疗（比值比（OR）0.42，95%置信区间（CI）0.20至0.86；P = 0.02）。比较噻氯匹定（一种血小板聚集抑制剂）与安慰剂的荟萃分析（三项RCT）的总体结果支持活性治疗（OR 0.47，95% CI 0.26至0.85；P = 0.01）。一项比较双嘧达莫与安慰剂以及双嘧达莫加阿司匹林与安慰剂效果的试验的总体结果支持治疗（OR分别为0.57，95% CI 0.13至2.51；OR 0.77，CI 0.19至3.19）。一项试验比较了鱼油（每日4克）与安慰剂，有24名参与者，随访12个月。总体结果支持治疗（OR 0.07，95% CI 0.01至0.49）。一项试验比较了低剂量华法林与安慰剂，107名患者随访37个月，但由于治疗组出血事件增加，该试验提前终止。总体结果支持安慰剂（OR 1.76，95% CI 0.78至3.99）。一项试验比较了磺吡酮与安慰剂。16名患者，随访3个月，总体结果支持治疗（OR 0.14，95% CI 0.01至1.99）。最后，一项试验比较了氯吡格雷（每日75毫克）与安慰剂。24名患者，随访三年直至首次发生血栓形成。总体结果支持治疗（OR 0.01，95% CI 0.00至0.15）。
荟萃分析证实了抗血小板治疗作为辅助治疗在短期内增加A-V内瘘和人工血管通畅性方面的有益作用。
