Clopidogrel versus acetyl salicylic acid in arteriovenous fistula salvage

Background: The optimal vascular access for chronic hemodialysis is the arteriovenous fistula (AVF). Several studies suggest a role for antiplatelet agents in the prevention of early AVF failure. Aim of the study: This trial was conducted to assess the efficacy and safety of clopidogrel versus acetyl salicylic acid in hemodialysis patients. Patients and Methods: A total of 50 patients received 75 mg/day of clopidogrel, 50 patients received 150 mg/day of acetyl salicylic acid, and 50 patients served as the control group. The treatment was initiated 7–10 days before the surgery and continued up to 6 weeks postoperatively; thereafter, patients were monitored for 6 months. Results: The primary outcome was AVF failure 8 weeks after fistula creation. The primary AVF failures at 2 months were 32.5% in the acetyl salicylic acid group and 6.6% in the clopidogrel group. First hemodialysis from newly created AVF in the clopidogrel group was significantly more successful than that in the acetyl salicylic acid group. No life-threatening adverse event or severe bleeding was recorded in both groups. Conclusion: Clopidogrel seems to be effective and safe compared with acetyl salicylic acid in the prevention of primary AVF failure in hemodialysis patients.