Jingzhen Li1, Lijuan Wang1, Jinzhu Hu2, Gaosi Xu3. 1. Medical Center of the Graduate School, Nanchang University, Nanchang, PR China. 2. Department of Cardiology, Second Affiliated Hospital, Nanchang University, Nanchang, PR China. 3. Department of Nephrology, Second Affiliated Hospital, Nanchang University, No. 1, Minde Road, Nanchang 330006, PR China. Electronic address: gaosixu@163.com.
Abstract
BACKGROUND AND AIM: The efficacy and safety of warfarin therapy in hemodialysis (HD) patients with atrial fibrillation (AF) remains controversial. Thus, we performed, up to date, the first meta-analysis on the risks of stroke and bleeding in warfarin treatment in these populations. METHODS AND RESULTS: The relevant literature was searched using the following electronic databases without any language restrictions: the Cochrane Library Database, PubMed, ISI, Ovid, and Chinese Biomedical Database from the establishment of the database to October 2014. The studies were included if (a) studies described the risk of stroke or bleeding with or without warfarin in dialysis patients with AF, (b) studies provided information about hazard ratio (HR) and 95% confidence interval (CI) of stroke or bleeding, and (c) the study design was a clinical cohort. The inverse variance method was used to obtain overall HRs and 95% CIs. Sensitivity analyses and publication bias were also performed. We identified six eligible studies with a total of 9816 patients. Combined HRs showed that warfarin cannot prevent strokes in HD patients with AF (HR = 1.23, 95% CI 0.80-1.87; P = 0.347), but its use was associated with a higher risk of bleeding (HR = 1.20, 95% CI 1.03-1.39; P = 0.019). CONCLUSION: This meta-analysis suggested that warfarin should not be recommended for the routine treatment of HD patients with AF.
BACKGROUND AND AIM: The efficacy and safety of warfarin therapy in hemodialysis (HD) patients with atrial fibrillation (AF) remains controversial. Thus, we performed, up to date, the first meta-analysis on the risks of stroke and bleeding in warfarin treatment in these populations. METHODS AND RESULTS: The relevant literature was searched using the following electronic databases without any language restrictions: the Cochrane Library Database, PubMed, ISI, Ovid, and Chinese Biomedical Database from the establishment of the database to October 2014. The studies were included if (a) studies described the risk of stroke or bleeding with or without warfarin in dialysis patients with AF, (b) studies provided information about hazard ratio (HR) and 95% confidence interval (CI) of stroke or bleeding, and (c) the study design was a clinical cohort. The inverse variance method was used to obtain overall HRs and 95% CIs. Sensitivity analyses and publication bias were also performed. We identified six eligible studies with a total of 9816 patients. Combined HRs showed that warfarin cannot prevent strokes in HDpatients with AF (HR = 1.23, 95% CI 0.80-1.87; P = 0.347), but its use was associated with a higher risk of bleeding (HR = 1.20, 95% CI 1.03-1.39; P = 0.019). CONCLUSION: This meta-analysis suggested that warfarin should not be recommended for the routine treatment of HDpatients with AF.
Authors: Donato Gemmati; Francesco Burini; Anna Talarico; Matteo Fabbri; Cesare Bertocco; Marco Vigliano; Stefano Moratelli; Antonio Cuneo; Maria Luisa Serino; Francesco Maria Avato; Veronica Tisato; Rosa Maria Gaudio Journal: PLoS One Date: 2016-09-08 Impact factor: 3.240