Hartford Hospital, Hartford, CT 28805, USA.
Int J Clin Pract. 2010 Aug;64(9):1239-44. doi: 10.1111/j.1742-1241.2009.02329.x. Epub 2010 Apr 23.
The aim of this study was to evaluate the impact of antiplatelet agents on the thrombosis rates of arteriovenous fistulae and grafts used for haemodialysis access.
In this meta analysis, a systematic search of the literature was used to identify randomised controlled trials evaluating the effect of antiplatelet agents in graft or fistula thrombosis or bleeding. Two authors identified eligible trials and abstracted data on outcomes and study characteristics. The incidence of thrombosis was the primary outcome of interest and was calculated separately for studies evaluating grafts and those evaluating fistulae. A random-effects model was used for statistical pooling.
Ten trials were included in the analysis, nine of which reported outcomes on graft or fistula thrombosis. Antiplatelet agents reduced the rate of arteriovenous fistulae thrombosis (OR 0.54, 95% CI 0.31-0.94) but not grafts (OR 0.50, 95% CI 0.16-1.53). Both analyses had a moderate degree of statistical heterogeneity, likely because of differences in study design, antiplatelet agent and dose, as well as other possible factors. Review of bleeding events did not reveal a concerning risk of bleeding, but could not be statistically evaluated.
Antiplatelet agents reduce the rate of arteriovenous fistula thrombosis; however, at this time, research does not support the use of these agents for preventing arteriovenous graft thrombosis.
本研究旨在评估抗血小板药物对用于血液透析通路的动静脉瘘和移植物血栓形成率的影响。
在这项荟萃分析中，我们系统地检索了文献，以确定评估抗血小板药物对移植物或瘘管血栓形成或出血影响的随机对照试验。两位作者确定了合格的试验，并提取了关于结局和研究特征的数据。血栓形成的发生率是主要的观察终点，分别对评估移植物和瘘管的研究进行计算。使用随机效应模型进行统计学合并。
10 项试验被纳入分析，其中 9 项报告了移植物或瘘管血栓形成的结局。抗血小板药物降低了动静脉瘘血栓形成的发生率（OR 0.54，95%CI 0.31-0.94），但对移植物没有影响（OR 0.50，95%CI 0.16-1.53）。这两项分析都存在中度的统计学异质性，可能是由于研究设计、抗血小板药物和剂量以及其他可能的因素存在差异。对出血事件的审查没有发现出血风险增加的令人担忧的情况，但无法进行统计学评估。
抗血小板药物可降低动静脉瘘血栓形成的发生率；然而，目前，研究并不支持使用这些药物来预防动静脉移植物血栓形成。
