Yeh Chi-Hsiao, Huang Ting-Shuo, Wang Yao-Chang, Huang Pin-Fu, Huang Tzu-Yen, Chen Tzu-Ping, Yin Shun-Ying, Yu Yu-Wei
Division of Thoracic &: Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung 204, Taiwan.
Curr Vasc Pharmacol. 2016;14(4):353-9. doi: 10.2174/1570161114666160229115844.
To study the effect of antiplatelet agents on preventing arteriovenous (AV) fistulae thrombosis in hemodialysis (HD) patients after surgical thrombectomy (ST) for acute AV fistulae occlusion. Whether post-operative antiplatelet drugs have similar effects on the patency of AV fistula after surgical thrombectomy in patients with end-stage renal disease who undergo HD has not been investigated.
DESIGN, MATERIALS AND METHODS: We employed the Taiwan National Health Insurance Research Database (NHIRD) from 1999 to 2010 to assess the recurrent occlusion requiring ST and longevity of AV fistula after ST in 1049 patients on regular HD, with or without antiplatelet drugs.
From the propensity-score (PS)-matched NHIRD, Multivariate Cox model demonstrated that concomitant antiplatelet medication in the HD patients who received the first ST significantly reduced the duration of recurrent ST (adjusted hazard ratio (HR) 1.69; 95% confidence interval (CI) 1.22-2.35, p=0.002) and the longevity of the fistula (adjusted HR 1.79; 95% CI 1.31-2.46, p<0.001).
Treatment with antiplatelet drugs in HD patients did not prevent recurrent thrombosis requiring further ST, but significantly jeopardized the longevity of AV fistula after ST.
研究抗血小板药物对急性动静脉（AV）内瘘闭塞行手术取栓术（ST）后的血液透析（HD）患者预防AV内瘘血栓形成的效果。终末期肾病行HD的患者在手术取栓术后，术后抗血小板药物对AV内瘘通畅性是否有类似作用尚未得到研究。
设计、材料与方法：我们使用1999年至2010年的台湾全民健康保险研究数据库（NHIRD），评估1049例接受规律HD且使用或未使用抗血小板药物的患者在ST后需要再次ST的复发性闭塞情况以及AV内瘘的使用寿命。
从倾向评分（PS）匹配的NHIRD中，多变量Cox模型显示，接受首次ST的HD患者同时使用抗血小板药物可显著缩短再次ST的持续时间（调整后风险比（HR）1.69；95%置信区间（CI）1.22 - 2.35，p = 0.002）以及内瘘的使用寿命（调整后HR 1.79；95% CI 1.31 - 2.46，p < 0.001）。
HD患者使用抗血小板药物治疗并不能预防需要进一步ST的复发性血栓形成，但会显著缩短ST后AV内瘘的使用寿命。
