title: Warfarin use and the risks of stroke and bleeding in hemodialysis patients with atrial fibrillation: A systematic review and a meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  This meta-analysis suggested that warfarin should not be recommended for the routine treatment of HD patients with AF.
authors.affiliation: Medical Center of the Graduate School, Nanchang University, Nanchang, PR China.
authors.forename: Jingzhen
authors.initials: J
authors.lastname: Li
authors.affiliation: Medical Center of the Graduate School, Nanchang University, Nanchang, PR China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, Nanchang University, Nanchang, PR China.
authors.forename: Jinzhu
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Nephrology, Second Affiliated Hospital, Nanchang University, No. 1, Minde Road, Nanchang 330006, PR China. Electronic address: gaosixu@163.com.
authors.forename: Gaosi
authors.initials: G
authors.lastname: Xu
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications*; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D006435:Renal Dialysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Atrial fibrillation; Bleeding; Hemodialysis; Stroke; Warfarin