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Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis
OBJECTIVE: 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. METHODS: We searched PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane Library, grey literatur...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916629/ https://www.ncbi.nlm.nih.gov/pubmed/27386140 http://dx.doi.org/10.1136/openhrt-2016-000441 |
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author | Nochaiwong, Surapon Ruengorn, Chidchanok Awiphan, Rattanaporn Dandecha, Phongsak Noppakun, Kajohnsak Phrommintikul, Arintaya |
author_facet | Nochaiwong, Surapon Ruengorn, Chidchanok Awiphan, Rattanaporn Dandecha, Phongsak Noppakun, Kajohnsak Phrommintikul, Arintaya |
author_sort | Nochaiwong, Surapon |
collection | PubMed |
description | OBJECTIVE: 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. METHODS: 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. MAIN OUTCOME MEASURE: All-cause mortality, total stroke/thromboembolism and bleeding complications. RESULTS: 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). CONCLUSIONS: 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. |
format | Online Article Text |
id | pubmed-4916629 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-49166292016-07-06 Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis Nochaiwong, Surapon Ruengorn, Chidchanok Awiphan, Rattanaporn Dandecha, Phongsak Noppakun, Kajohnsak Phrommintikul, Arintaya Open Heart Meta-Analysis OBJECTIVE: 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. METHODS: 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. MAIN OUTCOME MEASURE: All-cause mortality, total stroke/thromboembolism and bleeding complications. RESULTS: 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). CONCLUSIONS: 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. BMJ Publishing Group 2016-06-16 /pmc/articles/PMC4916629/ /pubmed/27386140 http://dx.doi.org/10.1136/openhrt-2016-000441 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Meta-Analysis Nochaiwong, Surapon Ruengorn, Chidchanok Awiphan, Rattanaporn Dandecha, Phongsak Noppakun, Kajohnsak Phrommintikul, Arintaya Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis |
title | Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis |
title_full | Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis |
title_fullStr | Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis |
title_full_unstemmed | Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis |
title_short | Efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis |
title_sort | efficacy and safety of warfarin in dialysis patients with atrial fibrillation: a systematic review and meta-analysis |
topic | Meta-Analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916629/ https://www.ncbi.nlm.nih.gov/pubmed/27386140 http://dx.doi.org/10.1136/openhrt-2016-000441 |
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