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To the Editor: In their randomized trial, Dr Dember and colleagues¹ studied the effect of clopidogrel on early failure of arteriovenous fistulas. They concluded that clopidogrel was able to prevent thrombosis but did not lead to a higher incidence of functional fistulas. The authors made the valuable distinction between preventing thrombosis and providing patients with a functional fistula for dialysis. Functional vascular access is a major concern to dialysis patients and their clinicians, especially against the background of low primary patency rate of arteriovenous fistulas.

However, we are concerned about the use of antiplatelet and anticoagulation therapies as a means to prevent primary access failure. Access thrombosis has been cited as the most common reason for primary arteriovenous fistula failure.² Despite this, observational trials have failed to demonstrate a difference in the primary failure rates of arteriovenous fistulas in patients receiving antiplatelet and anticoagulation medications.^2-3 A possible explanation for this . . . [Full Text of this Article]

Raghav Wusirika, MD; Panduranga Rao, MD, DNB, MS
spandu@umich.edu
University of Michigan
Ann Arbor

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Effect of Clopidogrel on Early Failure of Arteriovenous Fistulas for Hemodialysis: A Randomized Controlled Trial
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