title: Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis.
abstract: To systematically review and meta-analyse the risk-benefit ratio of warfarin users compared with non-warfarin users in patients with atrial fibrillation (AF), who are undergoing dialysis.
  
  
  
  We searched PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane Library, grey literature, conference proceedings, trial registrations and also did handsearch. Cohort studies without language restrictions were included. Two investigators independently conducted a full abstraction of data, risk of bias and graded evidence. Effect estimates were pooled using random-effect models.
  
  
  
  All-cause mortality, total stroke/thromboembolism and bleeding complications.
  
  
  
  14 studies included 37 349 dialysis patients with AF, of whom 12 529 (33.5%) were warfarin users. For all-cause mortality: adjusted HR=0.99 (95% CI 0.89 to 1.10; p=0.825), unadjusted risk ratio (RR)=1.00 (95% CI 0.96 to 1.04; p=0.847). For stroke/thromboembolism: adjusted HR=1.06 (95% CI 0.82 to 1.36; p=0.676), unadjusted incidence rate ratio (IRR)=1.23 (95% CI 0.94 to 1.61; p=0.133). For ischaemic stroke/transient ischaemic attack, adjusted HR=0.91 (95% CI 0.57 to 1.45; p=0.698), unadjusted IRR=1.16 (95% CI 0.84 to 1.62; p=0.370). For haemorrhagic stroke, adjusted HR=1.60 (95% CI 0.91 to 2.81; p=0.100), unadjusted IRR=1.48 (95% CI 0.92 to 2.36; p=0.102). Major bleeding was increased among warfarin users; adjusted HR=1.35 (95% CI 1.11 to 1.64; p=0.003) and unadjusted IRR=1.22 (95% CI 1.07 to 1.40; p=0.003).
  
  
  
  Among dialysis patients with AF, warfarin therapy was not associated with mortality and stroke/thromboembolism, but significantly increased the risk of major bleeding. More rigorous studies are essential to demonstrate the effect of warfarin for stroke prophylaxis in dialysis patients with AF.
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Clinic, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Surapon
authors.initials: S
authors.lastname: Nochaiwong
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Clinic, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Chidchanok
authors.initials: C
authors.lastname: Ruengorn
authors.affiliation: Department of Pharmaceutical Care, Faculty of Pharmacy , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Rattanaporn
authors.initials: R
authors.lastname: Awiphan
authors.affiliation: Division of Nephrology, Department of Internal Medicine , Prince of Songkla University , Hat Yai, Songkhla , Thailand.
authors.forename: Phongsak
authors.initials: P
authors.lastname: Dandecha
authors.affiliation: Renal Division, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Kajohnsak
authors.initials: K
authors.lastname: Noppakun
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Arintaya
authors.initials: A
authors.lastname: Phrommintikul
keywords: RENAL DISEASE