This important trial reports that use of twice daily dipyridamole plus aspirin (DPA) extends the duration of AV graft patency in hemodialysis patients. Importantly, this benefit came without any clear increase in adverse events. Several caveats should be mentioned. The clinical benefit was modest at best, with a suggestion that duration of patency was extended by 6 weeks. Patients that were enrolled were likely at lower risk for adverse events (bleeding) than hemodialysis patients in general practice and duration of therapy with DPA was relatively short, making it difficult to speculate on durability of benefit or risk. While six weeks may seem like a short period, it does represent time spent without a central venous catheter. An important element of this study will be cost-analysis and quality of life scores. In the meantime, in carefully selected patients at low risk for bleeding (see study inclusion/exclusion criteria), the addition of DPA can be incorporated into a treatment strategy to prolong AV graft patency. Benjamin J Freda, DO