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2017 ; 4
(ä): 2054358117735532
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Warfarin Use in Hemodialysis Patients With Atrial Fibrillation: A Systematic
Review of Stroke and Bleeding Outcomes
#MMPMID29093823
Tsai C
; Marcus LQ
; Patel P
; Battistella M
Can J Kidney Health Dis
2017[]; 4
(ä): 2054358117735532
PMID29093823
show ga
BACKGROUND: Given the lack of clear indications for the use of warfarin in the
treatment of atrial fibrillation (AF) in patients on hemodialysis and the
potential risks that accompany warfarin use in these patients, we systematically
reviewed stroke and bleeding outcomes in hemodialysis patients treated with
warfarin for AF. OBJECTIVE: To systematically review the stroke and bleeding
outcomes associated with warfarin use in the hemodialysis population to treat AF.
DESIGN: Systematic review. SETTING: All adult hemodialysis patients. PATIENTS:
Patients on hemodialysis receiving warfarin for the management of AF.
MEASUREMENTS: Any type of stroke and/or bleeding outcomes. METHODS: MEDLINE(R)
In-Process & Other Non-Indexed Citations and MEDLINE(R) via OVID (1946 to January
11, 2017), and EMBASE via OVID (1974 to January 11, 2017) were searched for
relevant literature. Inclusion criteria were randomized controlled trials,
observational studies, and case series in English that examined stroke and
bleeding outcomes in adult population of patients (over 18 years old) who are on
hemodialysis and taking warfarin for AF. Studies with less than 10 subjects, case
reports, review articles, and editorials were excluded. Quality of selected
articles was assessed using Newcastle-Ottawa Scale (NOS). RESULTS: Of the 2340
titles and abstracts screened, 7 met the inclusion criteria. Two studies showed
an association between warfarin use and an increased risk of stroke (Hazard
Ratio: 1.93-3.36) but no association with an increased risk of bleed (HR:
0.85-1.04), while 4 studies showed no association between warfarin and stroke
outcomes (HR: 0.12-1.17) but identified an association between warfarin and
increased bleeding outcome (HR: 1.41-3.96). And 1 study reported neither
beneficial nor harmful effects associated with warfarin use. LIMITATIONS: The
major limitation to this review is that the 7 included studies were observational
cohort studies, and thus the outcome measures were not specified and
predetermined in a research protocol. CONCLUSION: Our systematic review
demonstrated that for patients with AF who are on hemodialysis, warfarin was not
associated with reduced outcomes of stroke but was rather associated with
increased bleeding events.