Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts

Gary Osborn; Xavier Escofet; Anthony Da Silva

doi:10.1002/14651858.CD002786.pub2

Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts

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Referencias

References to studies included in this review

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Andrassy K, Malluche H, Bornefeld H, Comberg M, Ritz E, Jesdinsky H, et al. Prevention of p.o. clotting of av. cimino fistulae with acetylsalicyl acid: Results of a prospective double blind study. Klinische Wochenschrift 1974;52(7):348‐9.

Crowther MA, Clase CM, Margetts PJ, Julian J, Lambert K, Sneath D, et al. Low‐intensity warfarin is ineffective for the prevention of PTFE graft failure in patients on hemodialysis: a randomized controlled trial. Journal of the American Society of Nephrology 2002;13(9):2331‐7.

Fiskerstrand CE, Thompson IW, Burnet ME, Williams P, Anderton JL. Double‐blind randomized trial of the effect of ticlopidine in arteriovenous fistulas for haemodialysis. Artificial Organs 1985;9(1):61‐3.

Grontoft KC, Mulec H, Gutierrez A, Olander R. Thromboprophylactic effect of ticlopidine in arteriovenous fistulas for haemodialysis. Scandinavian Journal of Urology and Nephrology 1985;19(1):55‐7.

Grontoft KC, Larsson R, Mulec H, Weiss LG, Dickinson JP. Effects of ticlopidine in A‐V fistula surgery in uremia. Fistual Study Group. Scandinavian Journal of Urology and Nephrology 1998;32(4):276‐83.

Harter HR, Burch JW, Majerus PW, Stanford N, Delmez JA, Anderson CB, et al. Prevention of thrombosis in patients on haemodialysis by low‐dose aspirin. New England Journal of Medicine 1979;301(11):577‐9.

Michie DD, Wombolt DG. Use of sulfinpyrazone to prevent thrombus formation in arteriovenous fistulas and bovine grafts of patients on chronic hemodialysis. Current Therapeutic Research, Clinical and Experimental 1977;22(1):196‐204.

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Schmitz PG, McCloud LK, Reikes ST, Leonard CL, Gellens ME. Prophylaxis of hemodialysis graft thrombosis with fish oil: double‐blind, randomized, prospective trial. Journal of the American Society of Nephrology 2002;13:184‐90.

Sreedhara R, Himmelfarb J, Lazarus JM, Hakim RM. Anti‐platelet therapy in graft thrombosis: results of a prospective, randomized double blind study. Kidney International 1994;45(5):1477‐83.

Trimarche H, Young P, Forrester M, Schropp J, Pereyra H, Fexias E. Clopidogrel diminishes hemodiaysis access graft thrombosis. Nephron. Clinical Practice 2006;102:128‐32.

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References to studies excluded from this review

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Albert FW, Schmidt U, Harzer R. Postoperative thromboprophylaxis for Cimino‐fistulae with sulfinpyrazone in comparison to acetylsalicylic acid. Krankenhausarzt 1978;51:712‐8.

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Dulude H, Kaplan M, Odland M, Marbury T, Hoggard JG, Ploth D, et al. Escalating single doses of CJC‐1004, a locally acting antithrombotic agent in hemodialysis patients with vascular access occlusion. Journal of the American Society of Nephrology 2001;12:287A.

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Janicki K, Bojarska SA, Pietura R, Janicka L. Preventive effects of ticlopidine on the incidence of late A‐V fistula thrombosis complications in haemodialyses patients. Annales Universitatis Mariae Curie Sklodowska Sectio D: Medicina 2003;58:215‐8.

Kaegi A, Pineo GF, Shimizu A, Trivedi H, Hirsh J, Gent M. The role of sulfinpyrazone in the prevention of arterio‐venous shunt thrombosis. Circulation 1975;52(3):497‐9.

Kaufman JS, O'Connor TZ, Zhang JH, Cronin RE, Fiore LD, Ganz MB, et al. Veterans Affairs Cooperative Study Group on Hemodialysis Access Graft Thrombosis. Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. Journal of the American Society of Nephrology 2003;14(9):2313‐21.

Krasinski Z, Dzieciuchowicz L, Kulesza J, Pietrzak I, Gabriel M, Krasinka B, Oszkinis G. Influence of long‐term therapy with low molecular weight heparin on patency of arterio‐venous fistula for hemodialysis. ERA ‐ EDTA ELI Congress Abstracts. 2004:360.

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Radmilovic A, Boric Z, Naumovic T, Stamenkovic M, Musikic P. Shunt thrombosis prevention in hemodialysis patients ‐ A double‐blind, randomized study: pentoxifylline vs placebo. Angiology 1998;38(7):499‐506.

References to ongoing studies

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Dember L, Kaufman J, Beck G, Dixon B, Gassman J, Greene T, et al. Dialysis Access Consortium (DAC) trial design: clopidogrel prevention of early AV fistula thrombosis. Journal of the American Society of Nephrology 2002;13:229A.

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Dember LM, Kaufman JS, Beck GJ, Dixon BS, Gassman JJ, Greene T, et al. Design of the dialysis access consortium (DAC) clopidogrel prevention of early AV fistula thrombosis trial. Clinical Trials 2005;2(5):413‐22.

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. Clinical Trials 2005;2(5):400‐12.

Fuster V, Charlton P, Boyd A. Clinical protocol. A phase IIb, randomized, multicenter, double‐blind study of the efficacy and safety of Trinam (EG004) in stenosis prevention at the graft‐vein anastomosis site in dialysis patients. Human Gene Therapy 2001;12(16):2025‐7.

Irish A. A randomised, double‐blind, placebo‐controlled, factorial‐design trial to assess the effect of aspirin and fish oil in the prevention of early thrombosis in arterio‐venous fistulae in patients with Stage IV or V chronic kidney disease requiring haemodialysis ‐ FAVOURED (Fish oil and Aspirin in Vascular acccess OUtcomes in REnal Disease). Cochrane Renal Group Prospective Trials Register [http://www.cochrane renal.org./dbsearch.php.]2007.

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Irish A. Fish oil and aspirin in vascular access outcomes in renal disease. Australasian Kidney Trials Network [http://www.uq.edu.au./aktn./index.html.]2007.

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Anon. Fish oil Inhibition of Stenosis in Haemodialysis grafts study. http://www.controlled‐trials.com/ISRCTN15838383/15838383 (accessed 18 May 2008)2007.

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Lok CE, Allon M, Donnelly S, Dorval M, Hemmelgarn B, Moist L, et al. Design of the fish oil inhibition of stenosis in hemodialysis grafts (FISH) study. Clinical Trials 2007;4(4):357‐67.

Mileti M, De Petri G, Bacchi M, Ogliari V, Pecchini F, Bufano G, et al. A trial to evaluate the efficacy of picotamide in preventing thrombotic occlusion of the vascular access in hemodialysis patients. Journal of Nephrology 1995;8(2):167‐72.

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Additional references

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Churchill DN, Taylor DW, Cook RJ, Laplante P, Barre P, Cartier P, et al. Canadian Hemodialysis Morbidity Study. American Journal of Kidney Disease 1992;19(3):214‐34.

Anonymous. NKF‐DOQI clinical practice guidelines for vascular access. National Kidney Foundation ‐ Dialysis Outcomes Quality Initiative. American Journal of Kidney Diseases 1997;30 Suppl 3:150‐91.

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Jadad AR, Moore RA, Carrol D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomised clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17(1):1‐12.

Kanterman RY, Vesely TM, Pilgram TK, Guy BW, Windus DW, Picus D. Dialysis access grafts: anatomic localisation of venous stenosis and results of angioplasty. Radiology 1995;195(1):135‐9.

Kaplan EL, Meier P. Non‐parametric estimation from incomplete observations. Journal of the American Statistical Association 1958;53:457‐81.

Metha S. Statistical summary of clinical results of vascular access procedures for haemodialysis. In: Sommer BG, Henry ML editor(s). Vascular Access for Hemodialysis‐II (Chapter 11). W L Gore, 1991:145‐57.

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Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12.

References to other published versions of this review

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Da Silva AF, Escofet X, Rutherford PA. Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD002786]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios en curso

Andrassy 1974

Methods	Study design: Randomised, double‐blind clinical trial Method of randomisation: independent statistician
Participants	Country: Germany No. of participants: 92 Sex: M=50, F=42 Inclusion criteria: end‐stage renal failure
Interventions	Treatment: Aspirin 500 mg daily (n=45) Control: Placebo (n=47)
Outcomes	Primary: Fistula thrombosis, 28 days follow up
Notes	Brescia‐Cimino fistula formation
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Crowther 2002

Methods	Study design: Randomised, double‐blind clinical trial Method of randomisation: concealed computer‐generated randomisation scheme
Participants	Country: Canada No. of participants: 107 Age: 20‐85 years Sex: M=61, F=46 Inclusion criteria: haemodynamic dependency or planned haemodialysis in near end‐stage renal disease patients. Exclusion criteria: recent major haemorrhage (within 6 months), allergy to warfarin, persistent thrombocytopenia, inability to take oral medications, already taking warfarin for other reasons at start of trial, expectation of recovery of renal function or life expectancy less than two months, lack of informed consent or inability to give informed consent. Number of participants prematurely discontinuing: placebo: 11 warfarin: 12
Interventions	Treatment: Warfarin variable dose with target INR 1.4‐1.9 Control: Placebo Duration: 37 months
Outcomes	Primary: Graft thrombosis
Notes	PTFE grafts Trial terminated November 2000 due to increased number of major bleeding events in treatment group
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Fiskerstrand 1984

Methods	Study design: Randomised, double‐blind, clinical trial Method of randomisation: Unclear
Participants	Country: United Kingdom No. of participants recruited:18 No. of participants who completed the trial:15 Inclusion criteria: patients requiring access surgery for chronic haemodialysis Exclusion criteria: patients requiring anti‐platelet or anticoagulant therapy; history of peptic ulcer; known bleeding disorder; platelet count < 100,000/mm³
Interventions	Treatment: Ticlopidine 250 mg bid Control: Placebo bid Duration: 1 month postoperation
Outcomes	Primary: Fistula thrombosis
Notes	Brescia‐Cimino AVF
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Grontoft 1985

Methods	Study design: Randomised, double‐blind clinical trial Methof of randomisation: Unclear
Participants	Country: Sweden No. of participants recruited: 42 Sex: M=28, F=14 Age: 24‐72 years No. of participants who completed the trial: 36 Losses to follow up: 3 received artificial grafts, 1 received other form of anticoagulant and 2 serious side effects suspected Inclusion criteria: patients undergoing fistula operation Exclusion criteria: patients with bleeding tendency; reduced platelet counts; receiving anticoagulants, anti‐inflammatories or platelet aggregation inhibitors
Interventions	Treratment: Ticlopidine 250 mg bid Control: Placebo bid Duration: 2 days pre and 4 weeks postoperation
Outcomes	Fistula thrombosis Platelet aggregation
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Grontoft 1998

Methods	Study design: Randomised, double‐blind, multicentre, clinical trial Method of randomisation: minimisation scheme based on the four weighted stratification variables of the participating centre
Participants	Country: Sweden and Finland No. of participants recruited: 258 No. of participants with evaluable grafts: 242 Sex: M=152, F=90 Inclusion criteria: patients with chronic renal failure predialysis or on dialysis; patients requiring AVF. Patients in whom first operation failed could be re‐entered after wash‐out period. Exclusion criteria: patients requiring anti‐platelet or anticoagulant therapy; history of hepatic disease; severe or malignant hypertension; gastrointestinal ulcer; bleeding disorder; reduced white blood cells or platelets
Interventions	Treatment: Ticlopidine 250 mg bid Control: Placebo bid Duration: 7 days pre and 28 days post‐surgery
Outcomes	Primary: Fistula thrombosis Secondary: Biochemical markers: urea, haemoglobin and cholesterol levels
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Harter 1979

Methods	Study design: Randomised, double‐blind, clinical trial Method of randomisation: Unclear
Participants	Country: United States No. of participants: 44 Sex: M=20, F=24 Inclusion criteria: patients undergoing chronic haemodialysis Exclusion criteria: recent gastrointestinal bleeding
Interventions	Treatment: Aspirin 160 mg/day Control: Placebo Duration: aspirin or placebo started 1 month postoperation and continued for approximately 5 months
Outcomes	Primary: Graft thrombosis
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Michie 1977

Methods	Study design: Randomised, double‐blind, clinical trial
Participants	Country: United States
Interventions	Treatment: Sulfinpyrazone 200 mg qds Control: Placebo
Outcomes	Primary: Graft thrombosis
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Schmitz 2002

Methods	Study design: Randomised, double‐blind clinical trial Method of randomisation: permuted block randomisation scale
Participants	Country: United States No. of participants: 24 Age: 46 ‐ 58 years Sex: M=11, F=13 Inclusion criteria: Newly placed PTFE graft Exclusion criteria: Patients needing fistula revision, history of gastro‐intestinal bleeding, already taking warfarin or an anti‐platelet agent, terminal or life‐threatening disease, pregnancy or malignant hypertension
Interventions	Treatment: 4000 mg fish oil once daily Control: Placebo Duration: 12 months
Outcomes	Primary: Graft thrombosis
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Sreedhara 1994

Methods	Study design: Randomised, double‐blind, parallel group study Method of randomisation: pre‐determined schedule.
Participants	Country: United States No. of participants recuited: 108 Sex: M=45, F=63 Age: Mean age 54.4 years, range 19‐84 1 participant excluded after receiving Brescia‐Cimino fistula Type I patients = 84 (patients who required a new AV ePTFE graft for chronic HD) Type II patients = 23 (patients on chronic HD with AV ePTFE with graft thrombosis requiring new graft Losses to follow up: 11
Interventions	1. Dipyridamole 75 mg tid with aspirin placebo qd 2. Dipyridamole placebo tid with aspirin 325 mg qd 3. Dipyridamole 75 mg tid with aspirin 325 mg qd 4. Dipyridamole placebo tid with aspirin placebo qd Duration: 18 months or until graft thrombosis
Outcomes	Primary: Graft thrombosis
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Trimarche 2006

Methods	Study design: Randomised clinical trial. Unclear if study was blinded or not
Participants	Country: Argentina
Interventions	Treatment: Clopidogrel 75 mg od Control: No treatment
Outcomes	Primary: Graft thrombosis
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

AV = arteriovenous
AVF = arteriovenous fistula
ePTFE = expanded polytetrafluoroethylene
F = females
HD = haemodialysis
M = males

qd = once a day
bid = twice a day
tid = three times a day

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Albert 1978	Study compares acetylsalicylic acid with sulfinpyrazone, no placebo group included so did not meet inclusion criteria.
Dulude 2001	Only abstract available; not enough data presented to allow adequate data extraction for meta‐analysis.
Janicki 2003	It was not a randomised trial as there is no mention of any randomisation process. There is no data on date of the study, thus the control group could have been a historical group. There is no information on how patency or thrombosis was assessed.
Kaegi 1975	Some patients were on warfarin at the start of the study. Other patients were started on these drugs during the trial.
Kaufman 2003	Not able to elicit numbers of thrombotic episodes from results.
Krasinski 2004	Not able to elicit numbers of thrombotic episodes from results.
Radmilovic 1998	The trial looked at external fistulas, a technique now not practised and numbers of thrombotic episodes could not be elicited from the results.

Characteristics of ongoing studies [ordered by study ID]

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Dember 2005

Trial name or title	Dialysis Access Consortium (DAC) Trial Design: Clopidogrel Prevention of Early AV Fistula Thrombosis
Methods
Participants	Haemodialysis patients with newly formed upper limb arteriovenous fistulae using native vein
Interventions	Placebo versus clopidogrel 75 mg once daily
Outcomes	Primary Outcome: Fistula patency at six weeks Secondary Outcome: Suitability for dialysis defined as the ability to achieve a dialysis machine blood flow of over 300 ml/min during either the fourth month following the fistula creation or the first month of fistula use, whichever occurs later
Starting date
Contact information
Notes

Dixon 2005

Trial name or title	Design of the Dialysis Access Consortium (DAC) Aggrenox prevention of access stenosis trial
Methods
Participants	Haemodialysis patients with newly formed arteriovenous grafts
Interventions	Aggrenox (containing dipyridamole and aspirin) versus placebo
Outcomes	Primary outcome: Primary unassisted patency (defined as time from access placement until thrombosis or an access procedure carried out to restore or maintain patency). Secondary outcome: Cumulative access patency
Starting date	2005
Contact information
Notes

Fuster 2001

Trial name or title	A phase IIb, randomised, multicentre, double‐blind study of the efficacy and safety of trinam in stenosis prevention at the graft‐vein anastomosis site in dialysis patients
Methods
Participants	Haemodialysis patients requiring arteriovenous fistula formation
Interventions	End to end anastomosis versus end to end anastomosis with Trinam application
Outcomes	Anastomotic stenosis measured by fistulography
Starting date
Contact information
Notes

Irish 2007

Trial name or title	FAVOURED (Fish oil and aspirin in vascular access outcomes in renal disease)
Methods
Participants	Stage 4 or 5 chronic kidney disease patients with arteriovenous fistulae
Interventions	Low‐dose aspirin and fish oil either alone or in combination
Outcomes	Primary outcome: Fistula patency at 3 months. Secondary outcomes: Patency at 6 months, primary patency time, secondary (assisted) patency time, adverse events (eg. bleeding)
Starting date	2007
Contact information
Notes

Lok 2007

Trial name or title	FISH (Fish oil Inhibition of Stenosis in Haemodialysis grafts study)
Methods
Participants	End‐stage renal disease patients with new PTFE grafts
Interventions	Fish oil versus placebo
Outcomes	Primary outcome: reduction in the number of thrombotic occlusions in vascular access
Starting date	2004
Contact information
Notes

Mileti 1995

Trial name or title	STOP (Shunt Thrombotic Occlusion Prevention with Picotamide)
Methods
Participants	Haemodialysis patients with arteriovenous shunt thrombotic occlusions
Interventions	Picotamide versus Placebo
Outcomes	Primary Outcome: reduction in the number of thrombotic occlusions in vascular access Secondary Outcomes: non‐fatal ischaemic stroke, non‐fatal myocardial infarction and vascular death
Starting date	1993
Contact information
Notes

Data and analyses

Open in table viewer

Comparison 1. Aspirin versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	3	173	Odds Ratio (M‐H, Fixed, 95% CI)	0.42 [0.20, 0.86]
Open in figure viewer Analysis 1.1 Comparison 1 Aspirin versus placebo, Outcome 1 Graft thrombosis.

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Comparison 2. Ticlopidine versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Fistulae thromboses at one month Show forest plot	3	312	Odds Ratio (M‐H, Fixed, 95% CI)	0.47 [0.26, 0.85]
Open in figure viewer Analysis 2.1 Comparison 2 Ticlopidine versus placebo, Outcome 1 Fistulae thromboses at one month.

Open in table viewer

Comparison 3. Dipyridamole versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.1 Comparison 3 Dipyridamole versus placebo, Outcome 1 Graft thrombosis.

Open in table viewer

Comparison 4. Dipyridamole + aspirin versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 4.1 Comparison 4 Dipyridamole + aspirin versus placebo, Outcome 1 Graft thrombosis.

Open in table viewer

Comparison 5. Warfarin versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 5.1 Comparison 5 Warfarin versus placebo, Outcome 1 Graft thrombosis.

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Comparison 6. Fish oil versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 6.1 Comparison 6 Fish oil versus placebo, Outcome 1 Graft thrombosis.

Open in table viewer

Comparison 7. Clopidogrel versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 7.1 Comparison 7 Clopidogrel versus placebo, Outcome 1 Graft thrombosis.

Open in table viewer

Comparison 8. Sulfinpyrazone (SF) versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 8.1 Comparison 8 Sulfinpyrazone (SF) versus placebo, Outcome 1 Graft thrombosis.

Analysis 1.1

Comparison 1 Aspirin versus placebo, Outcome 1 Graft thrombosis.

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Analysis 2.1

Comparison 2 Ticlopidine versus placebo, Outcome 1 Fistulae thromboses at one month.

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Analysis 3.1

Comparison 3 Dipyridamole versus placebo, Outcome 1 Graft thrombosis.

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Analysis 4.1

Comparison 4 Dipyridamole + aspirin versus placebo, Outcome 1 Graft thrombosis.

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Analysis 5.1

Comparison 5 Warfarin versus placebo, Outcome 1 Graft thrombosis.

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Analysis 6.1

Comparison 6 Fish oil versus placebo, Outcome 1 Graft thrombosis.

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Analysis 7.1

Comparison 7 Clopidogrel versus placebo, Outcome 1 Graft thrombosis.

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Analysis 8.1

Comparison 8 Sulfinpyrazone (SF) versus placebo, Outcome 1 Graft thrombosis.

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Comparison 1. Aspirin versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	3	173	Odds Ratio (M‐H, Fixed, 95% CI)	0.42 [0.20, 0.86]

Comparison 1. Aspirin versus placebo

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Comparison 2. Ticlopidine versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Fistulae thromboses at one month Show forest plot	3	312	Odds Ratio (M‐H, Fixed, 95% CI)	0.47 [0.26, 0.85]

Comparison 2. Ticlopidine versus placebo

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Comparison 3. Dipyridamole versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 3. Dipyridamole versus placebo

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Comparison 4. Dipyridamole + aspirin versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 4. Dipyridamole + aspirin versus placebo

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Comparison 5. Warfarin versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 5. Warfarin versus placebo

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Comparison 6. Fish oil versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 6. Fish oil versus placebo

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Comparison 7. Clopidogrel versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 7. Clopidogrel versus placebo

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Comparison 8. Sulfinpyrazone (SF) versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Graft thrombosis Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 8. Sulfinpyrazone (SF) versus placebo

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Referencias

References to studies included in this review

Andrassy 1974 {published data only}

Crowther 2002 {published data only}

Fiskerstrand 1984 {published data only}

Grontoft 1985 {published data only}

Grontoft 1998 {published data only}

Harter 1979 {published data only}

Michie 1977 {published data only}

Schmitz 2002 {published data only}

Sreedhara 1994 {published data only}

Trimarche 2006 {published data only}

References to studies excluded from this review

Albert 1978 {published data only}

Dulude 2001 {published data only}

Janicki 2003 {published data only}

Kaegi 1975 {published data only}

Kaufman 2003 {published data only}

Krasinski 2004 {published data only}

Radmilovic 1998 {published data only}

References to ongoing studies

Dember 2005 {published data only}

Dixon 2005 {published data only}

Fuster 2001 {published data only}

Irish 2007 {published data only}

Lok 2007 {published data only}

Mileti 1995 {published data only}

Additional references

Churchill 1992

DOQI 1997

Jadad 1996

Kanterman 1995

Kaplan 1958

Metha 1991

Schulz 1995

References to other published versions of this review

Cochrane 2003

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Characteristics of ongoing studies [ordered by study ID]

Data and analyses

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