| Objective:For patients with end-stage renal disease undergoing maintenance hemodialysis,autologous arteriovenous fistula is the first choice according to the recommendations of various guidelines.However,in the process of dialysis,internal fistula failure is often caused by factors such as vascular stenosis and secondary thrombosis.When AVF cannot meet the dialysis flow,further intervention is required,and studies have found that endovascular treatment is more advantageous than surgical treatment.However,60%of patients develop restenosis or thrombosis within 12 months after angioplasty.Some studies at home and abroad have shown that anti-platelet aggregation drugs such as clopidogrel and aspirin have certain effects in preventing internal fistula thrombosis and maintaining vascular patency.However,there is still a lack of long-term effects of the two drugs in patients with AVF stenosis after PTA.This study intends to analyze and evaluate the long-term efficacy of two antiplatelet aggregation drugs,aspirin and clopidogrel,in patients with AVF failure after PTA treatment.Methods:This study analyzed 88 patients who underwent PTA for AVF stenosis in the Department of Nephrology of Sichuan Mianyang 404 Hospital from October 1,2019 to December 31,2020.They were randomly divided into experimental group and control group after operation.45 patients in the experimental group were treated with clopidogrel 75mg daily,and 43 patients in the control group were treated with aspirin 0.1g daily.Oral drug therapy was given on the same day after operation for 3 months.The patients in the two groups were treated with hemodialysis for 2-3 times a week,4 hours per time,and anticoagulant with low molecular weight heparin routinely,while actively improving anemia,controlling blood pressure and preventing and treating renal osteopathy and other complications.The thrombin time,fibrinogen concentration,activated partial prothrombin time,red blood cell count,platelet count,hemoglobin,triglyceride and total cholesterol were measured before treatment.The patency of internal fistula and complications at 3,6,9 and 12 months after oral administration were followed up.Results:1.There were no significant differences in gender,age,primary disease,dialysis time,smoking status,coagulation function,blood lipids,blood routine,preoperative and postoperative vascular diameter between the two groups(P>0.05).Univariate binary Logistic regression analysis of primary patency showed that the related risk factors were as follows:age(OR:1.038 95%CI 1.007-1.069 P=0.015),platelet count(OR:1.008 95%CI 1.003-1.012 P=0.001)and fibrinogen concentration(OR:1.707 95%CI 1.132-2.574 P=0.011).The significant variables in the single factor(P<0.05)were included in the multivariate binary Logistic regression analysis.The end event is the failure of internal fistula caused by thrombus or internal fistula stenosis.The correlation between the analysis and the primary patency rate was statistically significant(P<0.05).The results suggest that platelet count is a risk factor affecting the patency rate after PTA(OR:0.986 95%CI 0.977-0.995 P=0.003)。2.Comparison of patency rate between the two groups:the fistula patency rates in 3,6,9 and 12 months were compared between the two groups.The patency rate of internal fistula in the experimental group was 95.6%,88.9%and 75.6%higher than that in the control group at 3,6 and 9 months after oral administration of antiplatelet aggregation drugs,and the difference was not statistically significant(P>0.05).In the 12th month,the patency rate of internal fistula was 71.1%in the experimental group and 46.5%in the control group,the difference was statistically significant(P<0.05).3.Comparison of adverse reactions between the two groups of patients:the main manifestations are gastrointestinal reactions,including upper abdominal pain,nausea,indigestion,etc.There were 6 patients in the clopidogrel group and 9 patients in the aspirin group,respectively,and their symptoms improved after taking oral gastric mucosal protective agents and/or acid suppressants.There were no serious complications such as gastrointestinal ulcer,perforation and gastrointestinal bleeding in the two groups,and the difference was not statistically significant(χ2=1.665,P>0.05).Conclusion:1.Platelet count is a risk factor for patency after PTA.2.By comparing the patency rate of fistula within 3,6,9 and 12 months between the two groups,it was suggested that clopidogrel(75 mg,once a day,for 3 months)was superior to aspirin(0.1 mg,once a day,for 3 months)in maintaining vascular patency(P<0.05). |
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