Safety of percutaneous tunneled hemodialysis catheter procedures in patients receiving concurrent clopidogrel therapy

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#IVTEAM #Intravenous literature: Martinez Salazar, G.M., Tan, C.S., Spearman, K., Wicky, S. and Wu, S. (2013) Safety of percutaneous tunneled hemodialysis catheter procedures in patients receiving concurrent clopidogrel therapy. The Journal of Vascular Access. September 10th. [epub ahead of print].

Abstract:

Purpose: Patients on clopidogrel are at increased risk of bleeding. This study was commenced to assess the incidence of bleeding in dialysis patients who underwent tunneled hemodialysis catheter procedures while on clopidogrel therapy.

Methods: This is a single center retrospective study of 25 (10 men, 15 women; median age 70) dialysis patients in whom clopidogrel could not be discontinued and underwent tunneled hemodialysis catheter insertion, removal or exchange between the period March 2010 to November 2011. The medical records of patients were reviewed and complications were classified according to the Society of Interventional Radiology system. Fifty-three procedures (22 insertions, 11 exchanges and 20 removals) were performed in these patients. The pre-procedural median platelet count, International Normalized Ratio and partial thromboplastin time were 195×103/dL (range 50-666), 1.1 (range 0.9-3.3) and 26.3 seconds (range 22.5-69.8) respectively.

Results and Conclusions: Forty-six procedures were performed in patients on clopidogrel and aspirin treatment. Five procedures were performed in patients while on clopidogrel in combination with aspirin and warfarin, and two procedures were performed with patients on clopidogrel alone. There were no documented bleeding complications from tunneled hemodialysis catheter procedures performed in patients on concurrent clopidogrel therapy in our study. Further prospective assessment with a larger cohort is necessary in order to validate these findings.

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