Impact of Antiplatelet and Anticoagulation Therapy on Hemodialysis Reliable Outflow Graft Patency.

BACKGROUND: The Hemodialysis Reliable Outflow (HeRO) graft combines an arteriovenous graft with a central venous stent, allowing for hemodialysis access in patients with end-stage renal disease limited by central venous stenosis. The impact of anticoagulation (AC) and antiplatelet (AP) medications on HeRO graft patency is unknown. METHODS: Institutional medical records were retrospectively queried for all HeRO graft procedures performed from 2014 to 2023. Data were collected on demographics, medical comorbidities, operative details, and perioperative AC/AP medication use. The Cox proportional hazards model was used to identify risk factors for loss of primary patency. RESULTS: A total of 232 patients with end-stage renal disease underwent HeRO graft implantation across 3 hospitals, with a median follow-up of 1.5 years. Perioperative AC/AP strategies included mono-antiplatelet therapy (MAPT, n = 38 [16.4%]), dual-antiplatelet therapy (DAPT, n = 57 [24.6%]), AC only (n = 38 [16.4%]), MAPT with AC (n = 66 [28.4%]), DAPT with AC (n = 28 [12.1%]), and none (n = 5 [2.2%]). Direct oral anticoagulants were used in 85 patients (36.6%). There were no differences in bleeding or thrombotic complications between groups (symptomatic hematoma, P = 0.96; pulmonary embolism, P = 0.45). One-year primary patency rates were highest among patients on AP therapy (16.7 ± 6.2% [no AP] vs. 40.2 ± 5.4% [MAPT] vs 33.7 ± 5.6% [DAPT], log-rank P = 0.016). There was no difference with AC use (38.6 ± 5.4% [no AC] vs. 28.8 ± 4.3% [AC], log-rank P = 0.11). After adjusting for patient factors, MAPT (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.35-0.83, P = 0.005) and DAPT (HR 0.64, 95% CI 0.41-1.01, P = 0.05) were protective of loss of primary patency, whereas AC (HR 1.07, 95% CI 0.76-1.50, P = 0.70) did not impact primary patency rates. CONCLUSION: Among patients undergoing HeRO graft implantation, the use of antiplatelet medications was associated with improved primary patency rates.

Duke Scholars

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