title: Warfarin Use and Risk of Stroke in Patients With Atrial Fibrillation Undergoing Hemodialysis: A Meta-Analysis.
abstract: In spite of the substantial burden of atrial fibrillation and associated elevated ischemic stroke risk in patients undergoing hemodialysis, the role of warfarin in these high-risk patients remains uncertain. Our objective was to clarify the association between warfarin use and risk of stroke for patients with atrial fibrillation undergoing dialysis.PubMed and Embase from January 1966 to January 2015 were searched to identify relevant studies. Inclusion criteria were cohort studies, patients with atrial fibrillation undergoing hemodialysis, and reported quantitative estimates of the multivariate adjusted relative risk (RR) and 95% confidence interval (CI) for future stroke associated with warfarin use. We identified 8 studies, with a total of 9539 participants and 706 stroke events. Three studies reported total stroke as primary endpoint and other studies reported ischemic stroke as primary endpoint. Pooling the results showed that warfarin use was associated with higher risk of any stroke (RR 1.50, 95% CI: 1.13-1.99). By stroke type, warfarin was not significantly linked to risk of ischemic stroke (RR 1.01, 95% CI: 0.65-1.57, P = 0.97), but was related to greater hemorrhagic stroke risk (RR 2.30, 95% CI: 1.62-3.27). Warfarin heightened overall bleeding risk (RR 1.27, 95% CI: 1.03-1.56), but not death (RR 0.67, 95% CI: 0.37-1.21).Among patients with atrial fibrillation undergoing hemodialysis, use of warfarin is associated with a higher risk of hemorrhagic stroke, but did not increase overall mortality.
authors.affiliation: From the Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan (ML and YLW); Stroke Center and Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, CA (JLS, NMR); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea (KSH); Division of Nephrology, Department of Internal Medicine, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan (WHH); Department of Neurosciences, Medical University of South Carolina (BO), Charleston, SC.
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Wu
authors.forename: Wen-Hong
authors.initials: WH
authors.lastname: Huang
authors.forename: Neal M
authors.initials: NM
authors.lastname: Rao
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D006801:Humans; D015233:Models, Statistical; D006435:Renal Dialysis; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin