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| |  Clopidogrel May Not Increase Suitability for Haemodialysis of Surgically Enlarged Fistulas CHICAGO -- May 13, 2008 -- A study published in the May 14 issue of the Journal of the American Medical Association suggests that clopidogrel may reduce the frequency of early blood clot formation in new surgically enlarged fistulas created for patients requiring dialysis. The medication also did not increase the proportion of these fistulas that subsequently became suitable for use during dialysis. The Dialysis Access Consortium, including Laura M. Dember, MD, Boston University School of Medicine, Boston, Massachusetts, and colleagues performed a multicentre, randomised, placebo-controlled trial to determine whether clopidogrel reduces early failure of haemodialysis fistulas. The study included 877 participants with end-stage renal disease or advanced chronic kidney disease who underwent surgical creation of a fistula. Participants were randomly assigned to receive clopidogrel (n = 441) or placebo (n = 436) for 6 weeks starting within 1 day after fistula creation. The researchers found that participants given clopidogrel had a 37% lower risk of fistula thrombosis at 6 weeks compared with participants in the placebo group. Among the 866 participants who had fistula patency assessed, 53 participants (12.2%) in the clopidogrel group experienced fistula thrombosis compared with 84 participants (19.5%) in the placebo group. However, among the 86% of fistulas assessed for suitability for use during dialysis, the percentage with suitability failure was high and did not differ between the clopidogrel group and the placebo group (61.8% vs 59.5%, respectively). "Clopidogrel reduces the incidence of early thrombosis of new arteriovenous fistulas but does not increase the proportion [of fistulas] that become suitable for dialysis," said the study authors. "The high rate of fistula suitability failure observed in this large trial, conducted at centres with a particular interest in haemodialysis vascular access, provides a compelling argument for additional efforts to identify mechanisms underlying fistula maturation failure, criteria for selecting suitable candidates for fistula creation, and interventions to enhance fistula maturation." SOURCE: Journal of the American Medical Association
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