MAIN ASPECTS OF MANAGEMENT OF HAEMODYNAMIC DISORDERS OF ARTERIOVENOUS FISTULAS IN PATIENTS ON HAEMODIALYSIS
DOI:
https://doi.org/10.11603/2414-4533.2025.3.15627Keywords:
arteriovenous fistula (anastomosis), antiplatelet therapy, thrombosis, stenosis, hemodynamic parameters, vascular accessAbstract
The aim of the work: to study the feasibility of antiplatelet therapy administration to prevent the occurrence of thrombotic, occlusive, and stenotic lesions of arteriovenous anastomoses site.
Materials and Methods. Patients underwent radiocephalic arteriovenous fistula (AVF) formation on the forearm, with a follow-up control examination 10 days, 3, 6, and 12 months after surgery. Patients of the 1st (control) group did not receive any antiplatelet agents in the postoperative period, 2nd (main) – received antiplatelet therapy daily for 12 months of observation. Depending on the type of pharmacological agent, the following research subgroups were identified: 2.1 – in the postoperative period the patients took acetylsalicylic acid (ASA, 100 mg daily, per os), 2.2 – platelet P2Y12 receptor inhibitor clopidogrel (75 mg daily, per os).
Results. A reliable increasing of primary patency index of AVF was observed in patients of the 2nd group 6 and 12 months after surgery, by 13.4 and 25.4 %, respectively regarding to control. A detailed analysis of the type of antiplatelet therapy showed that clopidogrel administration is the most effective, that is confirmed by an increase the indexes of primary patency of vascular access by 14.1 and 29.0 % compared to the indicators in patients of the 1st group. During 12 months of observation, thrombotic lesions of AVF were detected in 33.8 % of examined without antiplatelet therapy, 24.3 % – against the background of ASA, 17.8 % – of clopidogrel. Ultrasound examination revealed a positive effect of clopidogrel administration, reflecting a reliable increase the diameter of the efferent vein 12 months after surgery by 22.5 % compared to the data in patients without antiplatelet therapy.
Conclusions. The obtained results indicate the advisability of long-term use of antiplatelet agents (especially clopidogrel) for the purpose to improve the rate of AVF maturation and prevention of complications occurrence to improve the quality and duration of patients’ life on renal replacement therapy.
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