A 55-year-old kidney transplant patient developed extensive arteriovenous fistula thrombosis after a GLP-1 agonist dose escalation, with no other identifiable cause — highlighting a rare but potentially serious thrombotic complication.
Extensive thrombosisAV fistula, brachiocephalic vein, and both radial and ulnar arteries all thrombosed after GLP-1 dose escalation, with a completely negative hypercoagulability workup
What the researchers found
A 55-year-old African American female with a history of deceased donor renal transplantation developed:
• Extensive thrombosis of the left AV fistula
• Thrombosis extending to the brachiocephalic vein
• Thrombosis of both radial and ulnar arteries
• Symptoms: pain, swelling, erythema, fever, chills, and loss of palpable thrill over the fistula for approximately one week
Comprehensive prothrombotic workup (both inherited and acquired hypercoagulable states) was completely unremarkable. The only identifiable change was a recent dose escalation of her GLP-1 receptor agonist. After the drug was discontinued, no further thrombotic events occurred during follow-up, supporting a temporal and causal association.
Why it matters
With tens of millions of patients now taking GLP-1 drugs worldwide, even rare adverse events become clinically significant at scale. While GLP-1 agonists are generally cardiovascular-protective, this case adds to limited reports of thrombotic complications, particularly relevant for the growing population of kidney transplant and dialysis patients being prescribed these drugs for diabetes and obesity management.
How the study worked
Single patient case report documenting the clinical presentation, diagnostic workup (including venous and arterial Doppler ultrasound and comprehensive thrombophilia testing), treatment course, and follow-up outcome of a renal transplant patient who developed extensive AV fistula thrombosis temporally associated with GLP-1 agonist dose escalation.
What this study cannot tell us
Single case report — the lowest level of clinical evidence. Causation cannot be definitively established from temporal association alone. The patient had multiple risk factors for thrombosis (renal transplant, immunosuppression, AV fistula). The specific GLP-1 agonist and dose are not named in the abstract. Dehydration from reduced oral intake on GLP-1 therapy (a plausible contributing mechanism) is not discussed in the abstract.
How to read the evidence
Single case report representing the lowest level of clinical evidence. While the thorough negative workup and temporal association are suggestive, a single case cannot establish causality. It serves as a pharmacovigilance signal that may warrant further investigation in larger datasets.
When this study was published
Published in 2025, this case report is very recent and contributes to the evolving safety profile of GLP-1 agonists as their use expands rapidly across populations including kidney transplant recipients.
The bigger picture
GLP-1 agonists have demonstrated anti-atherosclerotic and cardiovascular benefits in large trials, but post-marketing surveillance continues to reveal rare adverse events. Thrombotic complications are particularly uncommon and counterintuitive given the class's vascular benefits. This case contributes to pharmacovigilance literature and raises the question of whether dehydration from GLP-1-induced appetite suppression or other mechanisms could promote clot formation in susceptible patients.
Questions still open
- Could GLP-1 agonist-induced dehydration from reduced appetite contribute to thrombotic events in susceptible patients?
- Should patients with AV fistulas or other vascular access devices be monitored more closely when starting or escalating GLP-1 therapy?
- Is this thrombotic risk class-wide or specific to certain GLP-1 agonists?
Common questions
Can GLP-1 drugs cause blood clots?
What is an AV fistula and why does thrombosis matter?
Read the original research
Extensive Arteriovenous Fistula Thrombosis With Glucagon-Like Peptide-1 Agonist.
Cureus, 17(7), e88015
Citation
Muneeb, Muhammad; Choi, Elizabeth; Rodriguez, Coralys; Goyal, Kanika; Bhura, Zainab; Hannoudi, Ghadeer. (2025). Extensive Arteriovenous Fistula Thrombosis With Glucagon-Like Peptide-1 Agonist.. Cureus, 17(7), e88015. https://doi.org/10.7759/cureus.88015