Indobufen and Clopidogrel Combination Improves AVF-PTA Efficacy, Reduces Restenosis and Inflammation

Patients undergoing percutaneous transluminal angioplasty (PTA) for arteriovenous fistula (AVF) dysfunction often face high rates of restenosis, limiting the long-term utility of their vascular access. Current standard-of-care typically involves antiplatelet therapy like clopidogrel to prevent thrombosis, but this alone is often insufficient to fully mitigate the inflammatory and proliferative responses leading to restenosis. Inflammation, particularly involving cytokines like TGF-β and IL-6, is a known driver of neointimal hyperplasia and subsequent restenosis. There's a critical need for adjunctive therapies that can both enhance antiplatelet effects and provide anti-inflammatory benefits to improve AVF patency.

This retrospective cohort study investigated the efficacy of indobufen combined with clopidogrel versus clopidogrel alone in 120 patients who underwent AVF-PTA. Patients were divided into two groups of 60 each using propensity score matching: a combination therapy group (indobufen + clopidogrel) and a conventional therapy group (clopidogrel alone). Researchers compared clinical efficacy at 7 days postoperatively, changes in AVF blood flow volume and velocity, serum TGF-β and IL-6 levels, and restenosis rates at 3 and 6 months post-PTA. Primary endpoints included clinical effective rate and restenosis rates.

The combination of indobufen and clopidogrel demonstrated superior outcomes across multiple metrics. The total clinical effective rate at 7 days postoperatively was significantly higher in the combination group (91.7% vs 76.7%, P = .024). This was accompanied by more significant improvements in AVF blood flow volume and velocity in the combination group (both P < .001). Inflammatory markers also showed favorable changes: the combination therapy group experienced greater reductions in serum TGF-β and IL-6 levels postoperatively (both P < .01).