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Warfarin use increases bleeding risk in hemodialysis patients with atrial fibrillation: A meta-analysis of cohort studies.
J Gastroenterol Hepatol. 2019 Jan 06;:
Authors: Hussain S, Siddiqui AN, Baxi H, Habib A, Hussain MS, Najmi AK
Abstract
AIM: Atrial fibrillation (AF) is one of the most common co-morbid conditions in hemodialysis patients and warfarin is widely prescribed anticoagulant to prevent thromboembolic complications in such patients. In the last decade, several epidemiological studies pointed out the risk of bleeding with the use of warfarin. So, this meta-analysis is aimed to assess the bleeding risk associated with the use of warfarin.
METHODS: This meta-analysis was conducted in accordance with the PRISMA guidelines. PubMed, Embase, Scopus, and Cochrane central databases were searched from inception to 10th June 2018. The primary outcome was to quantify the bleeding risk associated with warfarin use. The Secondary outcome was to assess the bleeding risk based on different subgroups. Review Manager (RevMan) version 5.3 was used for performing statistical analysis.
RESULTS: A total of 15 studies, constituting a pooled sample of 53,581 patients (37.14% female) were included. Of these, 17,469 were warfarin users. We found that warfarin use had a significant association with the bleeding risk. The pooled relative risk (RR) of bleeding was estimated to be 1.35 (95% CI: 1.18 to 1.53, p = < 0.00001) and the pooled RR of major bleeding (5 studies) was estimated to be 1.32 (95% CI: 1.07 to 1.63, p = 0.009). Subgroup analysis revealed a significant association of warfarin use with the intracranial haemorrhage/hemorrhagic stroke (9 studies) (pooled RR: 1.43 [95% CI: 1.20 to 1.71, p = <0.0001]).
CONCLUSIONS: The results indicate that warfarin use increases the risk of bleeding in hemodialysis patients with AF.
PMID: 30614083 [PubMed - as supplied by publisher]