194774Independent Medical College Faisalabad, Faislabad, Pakistan.
429580Gujranwala Medical College, Gujranwala, Pakistan.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211063882. doi: 10.1177/10760296211063882.
Hemodialysis is required for patients with end-stage renal disease (ESRD) that require arteriovenous (AV) grafts or fistulas for vascular access. These access points are prone to thrombosis. To determine the effect of medical adjuvant therapy on AV graft/fistula patency among patients with ESRD on hemodialysis. Adhering to the PRISMA 2020 statement, a systematic search was conducted until August 20, 2021, with keywords including arteriovenous graft, fistula, patency, thrombosis, hemodialysis, adjuvant treatment. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane. A random-effects model was employed using Review Manager 5.4 for data analysis. The meta-analysis pooled in 1985 participants with 1000 (50.4%) in the medical adjuvant treatment group. At a snapshot, medical adjuvant therapy reduced the risk for graft thrombosis (RR = 0.64, = .02). Notable medications included aspirin for graft thrombosis (RR = 0.36, = .006) and ticlopidine for fistula thrombosis (RR = 0.53, = .01). Certain antiplatelet therapies (aspirin and ticlopidine) reduced the number of patients with AV fistula/graft thrombosis among patients with high heterogeneity among the trials. Other therapies (fish oil, sulfinpyrazone, clopidogrel, and aspirin/dipyridamole) did not demonstrate significant improvement but may be promising once concrete evidence is available. Potential benefits of anti-platelet therapies may be explored to maintain the potency of AV grafts/fistulas through well-designed placebo-controlled trials and long-term follow-up.
血液透析需要终末期肾病 (ESRD) 患者使用动静脉 (AV) 移植物或瘘管进行血管通路。这些通路容易发生血栓形成。为了确定在接受血液透析的 ESRD 患者中，医学辅助治疗对 AV 移植物/瘘管通畅率的影响。本研究遵循 PRISMA 2020 声明，系统检索至 2021 年 8 月 20 日，关键词包括动静脉移植物、瘘管、通畅率、血栓形成、血液透析、辅助治疗。检索了以下数据库：PubMed、Scopus、Web of Science、CINAHL Plus 和 Cochrane。使用 Review Manager 5.4 进行数据分析，采用随机效应模型。荟萃分析纳入了 1985 名参与者，其中 1000 名（50.4%）接受了医学辅助治疗。在一个时间点，医学辅助治疗降低了移植物血栓形成的风险（RR=0.64，=0.02）。值得注意的药物包括阿司匹林治疗移植物血栓形成（RR=0.36，=0.006）和噻氯匹定治疗瘘管血栓形成（RR=0.53，=0.01）。某些抗血小板治疗（阿司匹林和噻氯匹定）降低了试验中高度异质性患者的 AV 瘘管/移植物血栓形成的患者数量。其他治疗方法（鱼油、磺吡酮、氯吡格雷和阿司匹林/双嘧达莫）没有显示出显著的改善，但一旦有确凿的证据，可能会有希望。可能需要探索抗血小板治疗的潜在益处，通过精心设计的安慰剂对照试验和长期随访来维持 AV 移植物/瘘管的效力。
