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Design of the Dialysis Access Consortium (DAC) Aggrenox Prevention Of Access Stenosis Trial.

Publication ,  Journal Article
Dixon, BS; Beck, GJ; Dember, LM; Depner, TA; Gassman, JJ; Greene, T; Himmelfarb, J; Hunsicker, LG; Kaufman, JS; Lawson, JH; Meyers, CM ...
Published in: Clin Trials
2005

BACKGROUND: Surgically created arteriovenous (AV) grafts are the most common type of hemodialysis vascular access in the United States, but fail frequently due to the development of venous stenosis. The Dialysis Access Consortium (DAC) Aggrenox Prevention of Access Stenosis Trial tests the hypothesis that Aggrenox (containing dipyridamole and aspirin) can prevent stenosis and prolong survival of arteriovenous grafts. METHODS: This is a multicenter, randomized, double-blind, placebo-controlled trial that will enroll 1056 subjects over four years with one-half year follow-up. Subjects undergoing placement of a new AV graft for hemodialysis are randomized to treatment with Aggrenox or placebo immediately following access surgery. The primary outcome is primary unassisted patency defined as the time from access placement until thrombosis or an access procedure carried out to maintain or restore patency. The major secondary outcome is cumulative access patency. Monthly access flow monitoring is incorporated in the study design to enhance detection of a hemodynamically significant access stenosis before it leads to thrombosis. RESULTS: This paper describes the key issues in trial design, broadly including: 1) ethical issues surrounding the study of a clinical procedure that, although common, is no longer the clinical intervention of choice; 2) acceptable risk (bleeding) from the primary intervention; 3) inclusion of subjects already receiving a portion of the study intervention; 4) inclusion of subjects with incident rather than prevalent qualifying clinical conditions; 5) timing of the study intervention to balance safety and efficacy concerns; and 6) the selection of primary and secondary study endpoints. CONCLUSIONS: This is the first, large, multicenter trial evaluating a pharmacologic approach to prevent AV graft stenosis and failure, an important and costly problem in this patient population. Numerous design issues were addressed in implementing the trial and these will form a roadmap for future trials in this area.

Duke Scholars

Published In

Clin Trials

DOI

ISSN

1740-7745

Publication Date

2005

Volume

2

Issue

5

Start / End Page

400 / 412

Location

England

Related Subject Headings

  • Vascular Patency
  • Statistics & Probability
  • Sample Size
  • Research Design
  • Renal Dialysis
  • Randomized Controlled Trials as Topic
  • Platelet Aggregation Inhibitors
  • Humans
  • Graft Occlusion, Vascular
  • Drug Combinations
 

Citation

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Dixon, B. S., Beck, G. J., Dember, L. M., Depner, T. A., Gassman, J. J., Greene, T., … DAC Study Group, . (2005). Design of the Dialysis Access Consortium (DAC) Aggrenox Prevention Of Access Stenosis Trial. Clin Trials, 2(5), 400–412. https://doi.org/10.1191/1740774505cn110oa
Dixon, Bradley S., Gerald J. Beck, Laura M. Dember, Thomas A. Depner, Jennifer J. Gassman, Tom Greene, Jonathan Himmelfarb, et al. “Design of the Dialysis Access Consortium (DAC) Aggrenox Prevention Of Access Stenosis Trial.Clin Trials 2, no. 5 (2005): 400–412. https://doi.org/10.1191/1740774505cn110oa.
Dixon BS, Beck GJ, Dember LM, Depner TA, Gassman JJ, Greene T, et al. Design of the Dialysis Access Consortium (DAC) Aggrenox Prevention Of Access Stenosis Trial. Clin Trials. 2005;2(5):400–12.
Dixon, Bradley S., et al. “Design of the Dialysis Access Consortium (DAC) Aggrenox Prevention Of Access Stenosis Trial.Clin Trials, vol. 2, no. 5, 2005, pp. 400–12. Pubmed, doi:10.1191/1740774505cn110oa.
Dixon BS, Beck GJ, Dember LM, Depner TA, Gassman JJ, Greene T, Himmelfarb J, Hunsicker LG, Kaufman JS, Lawson JH, Meyers CM, Middleton JP, Radeva M, Schwab SJ, Whiting JF, Feldman HI, DAC Study Group. Design of the Dialysis Access Consortium (DAC) Aggrenox Prevention Of Access Stenosis Trial. Clin Trials. 2005;2(5):400–412.
Journal cover image

Published In

Clin Trials

DOI

ISSN

1740-7745

Publication Date

2005

Volume

2

Issue

5

Start / End Page

400 / 412

Location

England

Related Subject Headings

  • Vascular Patency
  • Statistics & Probability
  • Sample Size
  • Research Design
  • Renal Dialysis
  • Randomized Controlled Trials as Topic
  • Platelet Aggregation Inhibitors
  • Humans
  • Graft Occlusion, Vascular
  • Drug Combinations