Intervention Review

Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts

  1. Gary Osborn2,
  2. Xavier Escofet3,
  3. Anthony Da Silva1,*

Editorial Group: Cochrane Peripheral Vascular Diseases Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 27 MAY 2008

DOI: 10.1002/14651858.CD002786.pub2

How to Cite

Osborn G, Escofet X, Da Silva A. Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD002786. DOI: 10.1002/14651858.CD002786.pub2.

Author Information

  1. 1

    Wrexham Maelor Hospital, Department of Vascular Surgery, Wrexham, UK

  2. 2

    Singleton Hospital, Swansea NHS Trust, Department of General Surgery, Swansea, Wales, UK

  3. 3

    University Hospital of Wales, Cardiff, UK

*Anthony Da Silva, Department of Vascular Surgery, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, UK.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 OCT 2008




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要


End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or an A-V interposition prosthetic shunt for haemodialysis.


To determine the effects of adjuvant drug treatment on the patency of fistulae and grafts in patients with ESRD who are undergoing haemodialysis by assessing the number of thrombotic episodes.

Search methods

The Cochrane Peripheral Vascular Diseases Group (PVD) searched their Specialised Register (last searched May 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2).

Selection criteria

RCTs of active drug versus placebo in patients with ESRD undergoing haemodialysis via an A-V fistula or prosthetic interposition A-V graft.

Data collection and analysis

For the update, two review authors (ADS, GO) independently assessed trial quality and ADS, XE, and GO extracted data. Information on adverse events was collected from the trials. The outcome measure analysed was the long-term fistula or graft patency rate.

Main results

The overall results of the meta-analysis (three RCTs) comparing aspirin versus placebo favoured treatment with aspirin (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.20 to 0.86; P = 0.02).
The overall result of the meta-analysis ( three RCTs) comparing ticlopidine (a platelet aggregation inhibitor) versus placebo favoured active treatment (OR 0.47, 95% CI 0.26 to 0.85; P = 0.01).
The overall result from one trial comparing the effect of dipyridamole versus placebo and dipyridamole plus aspirin versus placebo favoured treatment (OR 0.57, 95% CI 0.13 to 2.51; OR 0.77, CI 0.19 to 3.19, respectively).
One trial compared fish oil (4 g/daily) versus placebo with 24 participants, follow-up 12 months. The overall result favoured treatment (OR 0.07, 95% CI 0.01 to 0.49).
One trial compared low-dose warfarin with placebo, 107 patients were followed for 37 months but the trial was terminated prematurely due to increased bleeding events in the treatment group. The overall result favoured placebo (OR 1.76, 95% CI 0.78 to 3.99).
One trial compared sulfinpyrazone versus placebo. Sixteen patients, follow-up three months, and the overall result favoured treatment (OR 0.14, 95% CI 0.01 to 1.99).
Finally, one trial compared clopidogrel (75 mg/once daily) with placebo. Twenty-four patients, follow-up over a three-year period until their first episode of thrombosis. The overall result favoured treatment (OR 0.01, 95% CI 0.00 to 0.15).

Authors' conclusions

The meta-analysis confirmed the beneficial effect of anti-platelet treatment as an adjuvant used to increase the patency of A-V fistulae and grafts in the short term.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

Medical adjuvant treatment to increase the patency of arteriovenous fistulae and grafts used for renal dialysis

People with advanced kidney disease (end-stage renal disease) need dialysis to perform kidney functions. In haemodialysis, blood is filtered through a machine. To allow a large enough passage for blood to flow between the person and the machine, an artery and a vein can be surgically joined (to form an arteriovenous fistula) or an artificial graft (a substitute for a vein) is used to join the artery to the vein. These access points might last for years but can become blocked or infected. The review of trials found that anti-clotting drugs (anti-platelet drugs like aspirin) can keep these dialysis access points clear, at least in the short term. The review authors found ten randomised controlled trials of anti-platelet drugs such as ticlodipine, aspirin, dipyridimole and clopidogrel or anti-thrombotic and other drug treatment used to prevent blockages in the artery and vein access points for dialysis. Three trials of aspirin that involved a total of 173 participants gave an overall result favouring treatment. The follow-up time and the dosage of aspirin (325 mg/once daily; 500 mg/once daily; and 160 mg/once daily) were different in each of the trials. In three trials with a total 312 participants, ticlopidine (250 mg/twice daily) improved patency at one month compared with placebo (OR for loss of patency 0.47, range 0.26 to 0.85). Single trials involving from 16 to 36 participants compared dipyridimole, fish oil (4 g/daily), clopidogrel (75 mg/once daily) or sulfinpyrazone (a uricosuric drug) with placebo. Although the results favoured treatment the trials were small and single trials are insufficient to recommend use. One trial compared low dose warfarin with placebo. A total of 107 patients were followed for 37 months before the trial was terminated early because of major bleeding events in the treatment group. Some of the trials were from the 1970s and 80s. Most had a short follow-up period so that any benefits in the longer term are not clear. Information given on complications of the treatments was limited.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要







检索了Cochrane Peripheral Vascular Diseases Group (PVD) 的Specialised Register (2008年5月) 和Cochrane Central Register of Controlled Trials (CENTRAL) ( Cochrane Library, 2008年第2期)数据库中的相关文献。




对于纳入的文献,先由两名评价者 (ADS和GO)独立评价试验的质量,接下来由ADS、XE和GO等三位评价者进行数据提取。与不良反应相关的数据也会被收集。评估指标为长期使用瘘管或人工导管的畅通率。


3个随机对照试验将aspirin(阿司匹林)和安慰剂进行对比研究,对其数据进行Meta-分析的结果显示,使用aspirin进行治疗的效果更好(OR(比值比): 0.42,95% CI(可信区间): 0.20~0.86,P=0.02)。

另外3个随机对照试验将ticlopidine(噻氯吡啶)(一种血小板凝集抑制剂)和安慰剂进行对比研究,对其数据进行Meta-分析的结果显示,积极治疗的效果较好(OR: 0.47,95% CI: 0.26~0.85,P=0.01)。

1项研究的试验组分别使用dipyridamole(双嘧达莫)或dipyridamole合并aspirin,而对照组使用安慰剂;结果显示,治疗组的效果较好(OR: 0.57,95%CI: 0.13~2.51;OR: 0.77,95%CI:0.19~3.19)。

1项包含24名受试者,并持续追踪12个月的试验,比较了鱼油(每天4克)和安慰剂的效果,结果同样是治疗组效果较好(OR: 0.07,95%CI: 0.01~0.49)。

1项对107名患者持续追踪37个月的试验比较了低剂量warfarin(法华林,一种抗凝剂)和安慰剂的效果,但因治疗组中出血事件增加而不得不提早终止试验。此试验的结果是倾向于使用安慰剂(OR: 1.76,95%CI: 0.78~3.99)。

还有1个试验纳入16名患者,并持续追踪3个月,将sulfinpyrazone(磺吡酮,一种促尿酸排泄药)和安慰剂进行比较,其整体结果倾向于治疗组(OR: 0.14,95%CI: 0.01~1.99)。

最后1个试验包含24名患者,持续追踪到第一次出现栓塞为止,时间超过3年;试验将clopidogrel(氯吡格雷)(每天一次,每次75毫克)和安慰剂进行比较, 其整体结果倾向于治疗组(OR: 0.01,95%CI: 0.00~0.15)。





  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要



患有严重肾脏疾病(终末期肾脏疾病)的患者需要进行透析以维持肾脏功能。透析就是利用机器将血液进行过滤。为了提供一个足够大的通道让血液可以在患者和机器间流动,必须要利用手术方式将一条动脉和一条静脉联接(以形成动静脉瘘管)或是利用一条人工导管(替代静脉)将动脉接合至静脉上。这些连接可以使用数年,但是在使用过程中可能会发生阻塞或是感染。本综述发现,抗凝药物(抗血小板药物,例如aspirin)可以使得这些透析的连接在短期内保持畅通的状态。本综述纳入了10个随机对照试验,试验使用了ticlopidine(噻氯匹啶)、aspirin(阿司匹林)、dipyridamole(双嘧达莫)和clopidogrel(氯吡格雷)等抗血小板药物,以及抗栓塞药物和其他药物,以防止动静脉连接间的栓塞形成。其中有3个试验使用aspirin,试验总人数为173人,整体结果倾向于进行治疗。每个试验的随访时间和aspirin的使用剂量不尽相同(每天一次,分别为每次325、500和160毫克)。另外3个总计312名患者的试验中,第一个月里,试验组每天两次使用250毫克ticlopidine(噻氯匹啶),改善通透性结果优于安慰剂(OR值为0.47,95%可信区间0.26~0.85);对于纳入16至36人不等患者的单一试验,分别比较了使用dipyridamole、鱼油(每天4克)、clopidogrel (每天一次,一次75毫克)或是sulfinpyrazone (磺吡酮,一种促尿酸排泄药物)和安慰剂的效果,虽然结果都是倾向于进行治疗,但是由于试验样本很小,并且是单一试验,所以无法提供有效的证据支持。有一个试验比较了低剂量的抗凝剂warfarin(法华林)和安慰剂的效果,但没有得出有效结论;研究者对107名患者持续追踪了37个月,因在治疗组中出现了严重的出血事件而不得不提前停止。以上的部分试验是在上世纪70年代到80年代间进行的。大多数试验的随访时间较短,所以无法得知长期使用的效果。另外,治疗中出现并发症的报道也十分有限。


本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

翻译注解":本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。: China Effective Health Care Network



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要


使用藥物輔助治療來增加動靜脈?管(arteriovenous fistula)和導管(graft)的暢通

末期腎臟疾病(EndStage Renal Disease,ESRD)的病患通常需要動靜脈?管或是動靜脈人工導管來進行血液透析(haemodialysis)。




Cochrane Peripheral Vascular Diseases Group (PVD) 搜尋其Specialised Register (最後一次搜尋為 2008年5月) 及Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2008年, Issue 2).






將aspirin和安慰劑進行統合分析(3個隨機性對照試驗)的整體結果顯示,較傾向於使用 aspirin進行治療(勝算比(OR)值為0.42,95% 信賴區間(CI)值介於0.20至0.86,P值為0.02);若是將 ticlopidine(一種血小板凝集抑制劑)和安慰劑進行統合分析(3個隨機性對照試驗)的整體結果顯示,較傾向於使用進行主動性治療(OR值為0.47,95% CI值介於0.26至0.85,P值為0.01);將dipyridamole或dipyridamole併用 aspirin比較起安慰劑之功效時(1個試驗),整理結果顯示,較傾向於進行治療(OR值為0.57,95% CI值介於0.13至2.51;OR值為0.77,95% CI值介於0.19至3.19);有一個試驗對於24個受試者比較魚油(每天4公克)和安慰劑的功效,並持續追蹤12個月,整體結果顯示仍是傾向於進行治療(OR值為0.07,95% CI值介於0.01至0.49);有一個試驗比較抗凝血劑 warfarin和安慰劑的功效,並對107名病患持續追蹤37個月,但是此試驗因為在治療組中出現出血事件增加的狀況導致試驗提早終止,這個試驗的結果是傾向於使用安慰劑(OR值為1.76,95% CI值介於0.78至3.99);有一個試驗是將 sulfinpyrazone和安慰劑進行比較,並對16名病患持續追蹤3個月,整體結果傾向於進行治療(OR值為0.14,95% CI值介於0.01至1.99);最後,有一個試驗將clopidogre(每天一次75毫克)和安慰劑進行比較,對於24名病患持續追蹤超過3年直到第一次出現栓塞為止,整體果則是傾向於進行治療(OR值為0.01,95% CI值介於0.00至0.15)。




此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


具有嚴重腎臟疾病(末期腎臟疾病)的患者需要進行透析以維持腎臟功能。在進行透析的過程中,會利用一機器將血液進行過濾,為了提供一個夠大的通道讓血液可以在病患和機器間流動,必須要利用手術方式將一條動脈和一條靜脈接合(以形成動靜脈?管)或是利用一人工導管(替代靜脈)將動脈接合至靜脈,這些連接可以使用數年,但是在使用中可能會發生阻塞或是感染的情形。本試驗的回顧發現,抗血塊藥物(抗血小板藥物,例如 aspirin)可以使得這些透析之連接至少在短期內保持暢通的狀態。回顧的作者們發現了10個隨機性對照試驗,他們使用例如ticlodipine、aspirin、dipyridimole和 clopidogrel等抗血小板藥物、抗栓塞藥物、及其他藥物,這些用來預防進行透析的動脈和靜脈連接之栓塞。有3個試驗使用aspirin,試驗總人數為173人,整體結果傾向於進行治療,在每個試驗中所進行後續追蹤的期間和aspirin的使用劑量不盡相同(每天一次325、500和160毫克);在3個包含312名病患的試驗中,第一個月時,每天兩次使用250毫克ticlopidine的組別在改善通透性的結果上優於安慰劑(失去通透性的OR值為0.47,介於0.26至0.85之間);有多個試驗納入16至36人不等的病患,以比較使用 dipyridimole、魚油(每天4公克)、 clopidogrel(每天一次75毫克)或是 sulfinpyrazone(一種促尿酸排泄藥物)和安慰劑的效果,雖然結果都是傾向於進行治療,但是由於試驗規模很小,而且是單一試驗,所以無法給予有效的建議;有一個試驗是比較低劑量的抗凝血劑 warfarin和安慰劑,並針對107名病患持續追蹤37個月,但是因為在治療組中出現了嚴重的出血事件,所以在試驗期結束前便停止試驗。以上的一些試驗是1970年到1980年間進行的,大多數的這些試驗之追蹤期間較短,所以無法得知長期使用的效益,另外關於治療中所出現的併發症之資訊也十分有限。