Wednesday, December 16, 2015

AVG thrombosis-- can any drug prevent it?

AVG can clot and certain patients, they clot frequently.  What is the data on pharmacological interventions to improve AVG outcomes in terms of preventing further clots?

A recent article in CJASN discusses this nicely via a case of a patient who has numerous AVG and most clot within weeks  of creation. The authors discuss patho-physiology of thrombosis of AVG but then discuss the potential pharmacological options.  I encourage all to look at Table 1 as it summarizes the randomized controlled trials on major agents that we consider are useful in preventing clots.

Apparently, warfarin, ASA + clopidogrel showed no difference and were more harmful in causing bleeding. 

Lowering homocysteine levels by folic acid didn’t do much either. Only trials that showed benefit were the ones that used Fish oil.  One is a small single center trial that showed decrease in thrombosis and other was a multicenter trial that showed that fish oil (four 1-g capsules/day) halved the frequency of the AVG thrombosis and angioplasty.

Worth a read for all nephrologists!

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