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Pharmacotherapy to improve outcomes in vascular access surgery: a review of current treatment strategies

Jackson, Andrew and Coats, Paul and Kingsmore, David (2012) Pharmacotherapy to improve outcomes in vascular access surgery: a review of current treatment strategies. Nephrology Dialysis Transplantation. ISSN 0931-0509

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Renal failure is a major cause of morbidity in western Europe, with rising prevalence. Vascular access complications are the leading cause of morbidity among patients on haemodialysis. Considering the health care burden of vascular access failure, there is limited research dedicated to the topic. Randomised control trials of medications aimed at improving vascular access patency were identified using a medline search between January 1950 and January 2011. Thirteen randomised trials were identified, investigating antiplatelets, anticoagulants and fish oil in preserving vascular access patency. Outcomes are presented and reviewed in conjunction with the underlying pathophysiological mechanisms of failure of vascular access. Vascular access failure is a complex process. Most clinical trials so far have involved medications primarily aimed at preventing thrombosis. Other contributing pathways such as neointimal hyperplasia have not been investigated clinically. Improved outcomes may be seen by linking future therapies to these pathways.