 This study is a randomized, placebo-controlled, single blind clinical trial. Seventy patients with ESRD on chronic HD and a functioning AVF will be recruited. Consent form will be obtained. History and physical, dialysis parameters and laboratory data CBC, CMP, PTT INR will be obtained throughout the study. The following data will be documented on each patient: 1-Agegenderracebody weightcause of ESRD 2-Vintage of HD 3-Time since access was placed 4-Type and place of access and blood flow rate of access 5-History of prior access problems 6-Comorbid conditions Hypertension, coronary artery disease, Diabetes Mellitus, Bleeding problems, peripheral vascular disease. 7-Current medications Coumadin, Erythropoiesis stimulating agents, heparin, other antiplatelets, digoxin, statins. Patients will be randomized into two groups to receive: Group 1: Ticagrelor 90 mg PO BID Group 2: Placebo drug PO BID. 