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WARFARIN USE AND THE RISKS OF STROKE AND BLEEDING IN HEMODIALYSIS PATIENTS WITH ATRIAL FIBRILLATION: A META-ANALYSIS STUDY

Dr. Ibn-e-Hassan, Dr. Usama Saeed, Dr. Mina Amer

Abstract: Background: risk and benefits of warfarin therapy in hemodialysis (HD) patients with fibrillation (AF) remains controversial. The aim of meta-analysis to evaluate risks of stroke and bleeding of warfarin treatment in these populations. Methods and results: Relevant literatures were searched using the following electronic databases without any language restrictions: the Cochrane Library Database, PubMed, ISI, Ovid, and Chinese Biomedical Database from the building of the database to 2018. 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 should be a clinical cohort. Sensitivity analyses and publication bias were also performed. We identified 6 eligible studies with a total of 9816 patients. Combined HRs showed that warfarin cannot provide a prevention for strokes in HD patients with AF [HR = 1.23, 95% CI 0.80 - 1.87; P = 0.347], but 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. Keywords: Hemodialysis, Atrial fibrillation, Warfarin, Stroke, Bleeding.

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